Provider Demographics
NPI:1104907831
Name:BLUM, MONICA CAROLINE (PHD)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:CAROLINE
Last Name:BLUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 RARITAN AVE
Mailing Address - Street 2:SUITE #120
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2440
Mailing Address - Country:US
Mailing Address - Phone:732-296-8046
Mailing Address - Fax:732-296-8046
Practice Address - Street 1:47 RARITAN AVE
Practice Address - Street 2:SUITE #120
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2440
Practice Address - Country:US
Practice Address - Phone:732-296-8046
Practice Address - Fax:732-296-8046
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI 03530103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ002188Medicare ID - Type Unspecified