Jerry Blume, LICSW

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

LICSW12647 Issued in MN

Practice address

1523 Highway 13 E
Burnsville, MN 55337-2917

Phone

(952) 894-4828

Fax

(952) 894-3737

NPI assigned

Sep 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1518067701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1523 HIGHWAY 13 E",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553372917",
            "telephone_number": "952-894-4828",
            "fax_number": "952-894-3737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1523 HIGHWAY 13 E",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553372917",
            "telephone_number": "952-894-4828",
            "fax_number": "952-894-3737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUME",
        "first_name": "JERRY",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MN",
            "license": "LICSW12647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP34163",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA  UBH",
            "identifier": "6261296",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN BCBS",
            "identifier": "340M8BL",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Cognitive & Behavioral Psychologist in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Cognitive & Behavioral Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.