Provider Demographics
NPI:1124298534
Name:LORRAINE J. BLUM, LCSW PA
Entity type:Organization
Organization Name:LORRAINE J. BLUM, LCSW PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRSCHBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-784-2845
Mailing Address - Street 1:6352 OVERLAND DR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-1574
Mailing Address - Country:US
Mailing Address - Phone:561-866-9041
Mailing Address - Fax:954-785-5808
Practice Address - Street 1:6352 OVERLAND DR
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-1574
Practice Address - Country:US
Practice Address - Phone:561-866-9041
Practice Address - Fax:561-495-4994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW11941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ1744OtherMEDICARE PTAN NUMBER