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NPI Code Detail

MEDICARE: SUSAN I BLUMENTHAL LCSW-R

MEDICARE:   SUSAN I BLUMENTHAL  LCSW-R
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
11041C0700XClinical Social WorkerR61823-1NY

General Provider Information

NPI Number : 1205998218
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN I BLUMENTHAL LCSW-R
Provider Business Mailing Address
First Line : 312 WOODBRIDGE AVE
Second Line :
City : BUFFALO
State : NY
Zip : 14214-1517
Country : US
Telephone Number : 716-834-9560
Fax Number :
Provider Business Practice Location Address
First Line : 162 MAIN ST
Second Line :
City : HAMBURG
State : NY
Zip : 14075-4917
Country : US
Telephone Number : 716-984-5042
Fax Number : 716-648-2760
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2006
Last Update Date : 07/08/2007

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Directions to “ SUSAN I BLUMENTHAL LCSW-R” Practice Location

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