Jesse Samuel Goldblum

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

13775 Issued in CT

Practice address

1680 Albany Ave
Hartford, CT 06105-1001

Phone

(860) 297-0520

NPI assigned

Oct 11, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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": "1696982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735948800000",
    "number": "1407637895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 MARVEL RD APT B2",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065152169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 ALBANY AVE",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061051001",
            "telephone_number": "860-297-0520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDBLUM",
        "first_name": "JESSE",
        "middle_name": "SAMUEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-10-11",
        "last_updated": "2025-01-04",
        "certification_date": "2025-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CT",
            "license": "196780",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CT",
            "license": "13775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John W Goethe, M.D.
• Sheree Goffe
• Kristen H. Goiangos, LCSW
• Aimee Carol Golbert, MSW
• Robin B. Gold, M.D.
• Golden Aged Homecare
• Golden Touch Personal Care LLC
• Alex Brian Golden, MD
• Lindsey Golden, LCSW
• Ashley Sooyoung Goldman

• Psychiatric/Mental Health Nurse Practitioner in Hartford, CT
• Providers in Hartford, CT by specialty
• Psychiatric/Mental Health Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2025; 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.