Provider Demographics
NPI:1285459057
Name:DANIEL BLUMENTHAL LCSW LLC
Entity type:Organization
Organization Name:DANIEL BLUMENTHAL LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LOGUE
Authorized Official - Last Name:BLUMENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:971-300-2306
Mailing Address - Street 1:2530 NE SARATOGA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-5958
Mailing Address - Country:US
Mailing Address - Phone:971-300-2306
Mailing Address - Fax:
Practice Address - Street 1:2530 NE SARATOGA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-5958
Practice Address - Country:US
Practice Address - Phone:971-300-2306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)