Elizabeth Susan Blumberg, PSY.D.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

5027 Issued in MA

Practice address

130 2ND Ave
Boston Ivf - Domar Center for Mind/Body Health
Waltham, MA 02451-1100

Phone

(781) 434-6578

Fax

(781) 370-2330

NPI assigned

Jun 13, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191974400000",
    "number": "1154525194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 2ND AVE",
            "address_2": "BOSTON IVF - DOMAR CENTER FOR MIND/BODY HEALTH",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024511100",
            "telephone_number": "781-434-6578",
            "fax_number": "781-370-2330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 2ND AVE",
            "address_2": "BOSTON IVF - DOMAR CENTER FOR MIND/BODY HEALTH",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024511100",
            "telephone_number": "781-434-6578",
            "fax_number": "781-370-2330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUMBERG",
        "first_name": "ELIZABETH",
        "middle_name": "SUSAN",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-13",
        "last_updated": "2007-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "5027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Eve O'Donnell Blake, PA-C
• Bliss Healthcare, LLC
• Bloom International Doula LLC
• Jamie Bloom, DPT
• Ashley Elizabeth Blum, BA
• Chanel Blunt
• Semen Bobrovskii, HIS
• Naomi Bocarsly, LICSW
• Dorothy Ruth Bogard
• Peter Allen Bogart, DC

• Mental Health Counselor in Waltham, MA
• Providers in Waltham, MA by specialty
• Mental Health Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.