MEDICARE: JAN BLUMENTHAL M.ED,LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	PC007623	PA

General Provider Information

NPI Number	:	1114370103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAN BLUMENTHAL M.ED,LPC

Provider Business Mailing Address
First Line	:	237 E. LANCASTER AVE.
Second Line	:	SUITE 221
City	:	DEVON
State	:	PA
Zip	:	19333
Country	:	US
Telephone Number	:	610-246-3051
Fax Number	:

Provider Business Practice Location Address
First Line	:	613 VALLEY FORGE RD
Second Line	:
City	:	WAYNE
State	:	PA
Zip	:	19087-3837
Country	:	US
Telephone Number	:	610-246-3051
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JAN BLUMENTHAL
Credential	:	M.ED, LPC
Telephone Number	:	610-246-3051

Provider Enumeration Date	:	07/14/2016
Last Update Date	:	07/14/2016

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