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NPI Code Detail

MEDICARE: DR. STEPHEN R BLUMBERG PHD

MEDICARE: DR. STEPHEN R BLUMBERG PHD
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
1103TC0700XClinical Psychologist3334MA

General Provider Information

NPI Number : 1518061761
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN R BLUMBERG PHD
Provider Business Mailing Address
First Line : PO BOX 243877
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33424-3877
Country : US
Telephone Number : 561-254-9434
Fax Number : 954-566-1186
Provider Business Practice Location Address
First Line : 915 MIDDLE RIVER DR
Second Line : SUITE 307
City : FORT LAUDERDALE
State : FL
Zip : 33304-3544
Country : US
Telephone Number : 561-254-9434
Fax Number : 954-566-1186
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2006
Last Update Date : 11/05/2014

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