Provider Demographics
NPI:1285143248
Name:BLUM, LYNNE ANNE (PHD)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:ANNE
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 1:2 HAMILL RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1806
Mailing Address - Country:US
Mailing Address - Phone:410-371-3371
Mailing Address - Fax:
Practice Address - Street 1:2 HAMILL RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1806
Practice Address - Country:US
Practice Address - Phone:410-371-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4146103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist