MEDICARE: DR. HOWARD F BLUMENFELD PHD MFT

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	106H00000X	Marriage & Family Therapist	MFC18747	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MFC18747	OTHER	CA	BBS

General Provider Information

NPI Number	:	1275617896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOWARD F BLUMENFELD PHD MFT

Provider Business Mailing Address
First Line	:	5636 GENTRY AVE
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607
Country	:	US
Telephone Number	:	818-487-3773
Fax Number	:	818-769-6434

Provider Business Practice Location Address
First Line	:	5636 GENTRY AVE
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-1817
Country	:	US
Telephone Number	:	818-487-3773
Fax Number	:	818-769-6434

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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