MEDICARE: MS. CAROL ANN BLUM M.ED., CAC, 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	101YP2500X	Professional Counselor	PC003059	PA

General Provider Information

NPI Number	:	1811231186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL ANN BLUM M.ED., CAC, LPC

Provider Business Mailing Address
First Line	:	2446 ASPEN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-2504
Country	:	US
Telephone Number	:	267-978-8089
Fax Number	:

Provider Business Practice Location Address
First Line	:	2446 ASPEN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-2504
Country	:	US
Telephone Number	:	267-978-8089
Fax Number	:

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

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	11/26/2012

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