Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 012331 | NY |
Y | 103TC0700X | Clinical Psychologist | 012331 | NY |
N | 103TH0004X | Health Psychologist | 012331 | NY |
NPI | 1528078664 |
---|---|
Provider Name | Edna Blumstein |
First Address | Lynbrook, NY 11563-1614 |
Second Address | Lynbrook, NY 11563-1614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 10/07/2007 |