Provider Demographics
NPI:1154525194
Name:BLUMBERG, ELIZABETH SUSAN (PSYD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUSAN
Last Name:BLUMBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 2ND AVE
Mailing Address - Street 2:BOSTON IVF - DOMAR CENTER FOR MIND/BODY HEALTH
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1100
Mailing Address - Country:US
Mailing Address - Phone:781-434-6578
Mailing Address - Fax:781-370-2330
Practice Address - Street 1:130 2ND AVE
Practice Address - Street 2:BOSTON IVF - DOMAR CENTER FOR MIND/BODY HEALTH
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1100
Practice Address - Country:US
Practice Address - Phone:781-434-6578
Practice Address - Fax:781-370-2330
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5027101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health