Active NPI
Michelle Rose Blumenthal, PSY.D.
- Clinical Psychologist
- Rockville, MD
National Provider Identifier
1073859211
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 05649
- Practice address
- 25 Wood LN
Rockville, MD 20850-2228 - Phone
- (301) 941-7838
- NPI assigned
- Dec 17, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0810004666 | VA | |
| Clinical Psychologist | 103TC0700X | 05649 | MD | Primary |
Addresses
Primary practice location
25 Wood LN
Rockville, MD 20850-2228
Mailing address
25 Wood LN
Rockville, MD 20850-2228
Phone (301) 941-7838
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2019 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05649 | MD | MD | Clinical Psychologist |
| 0810004666 | VA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756080000000",
"number": "1073859211",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 WOOD LN",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208502228",
"telephone_number": "301-941-7838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 WOOD LN",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208502228",
"telephone_number": "301-941-7838"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLUMENTHAL",
"first_name": "MICHELLE",
"middle_name": "ROSE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-12-17",
"last_updated": "2025-08-25",
"certification_date": "2025-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810004666",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "05649",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.