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NPI Code Detail

MEDICARE: BRENDON BLUESTEIN PHD

MEDICARE:   BRENDON  BLUESTEIN  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 Psychologist1160AL

General Provider Information

NPI Number : 1669661500
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDON BLUESTEIN PHD
Provider Business Mailing Address
First Line : 7538 WILL ST
Second Line :
City : FORT MEADE
State : MD
Zip : 20755-1050
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7538 WILL ST
Second Line :
City : FORT MEADE
State : MD
Zip : 20755-1050
Country : US
Telephone Number : 301-677-2746
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2007
Last Update Date : 10/16/2007

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Directions to “ BRENDON BLUESTEIN PHD” Practice Location

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