Judy Lynn Blumenfeld, PHD
Individual provider Active NPI Clinical Psychologist · Mequon, WI
NPI 1891868253 · NPPES record last updated Nov 14, 2024
Key facts
- NPI
- 1891868253
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 755 (WI)
- Practice address
- 1500 W Market St Ste 200
Mequon, WI 53092-5083 - Phone
- (262) 241-5955
- Fax
- (262) 241-5926
- NPI assigned
- Nov 15, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 1977
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- North Shore Center LLC
Practice addresses (Care Compare)
1500 W Market St
Suite 200
Mequon, WI 53092-5083
Phone (262) 241-5955
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120410000368 | WI | Practitioner - Clinical Psychologist | 7911168414 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 755 | WI | MD | Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Shore Center LLC | Current |
Accepting new patients |
Locations
1500 W Market St
Ste 200
Mequon, WI 53092
Phone (262) 241-5955
10303 N Port Washington Rd
Ste 203
Mequon, WI 53092
Phone (262) 241-5955
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 755 | WI | Yes |
Addresses
Primary practice location
1500 W Market St Ste 200
Mequon, WI 53092-5083
Mailing address
1500 W Market St Ste 200
Mequon, WI 53092-5083
Phone (262) 241-5955
Other providers in Mequon, WI
- Roberta L. Bloch
- Karen Irene Block
- Byron C Bloemer
- Kelly Marie Blonien
- Bloom Speech Therapy LLC
- Kara Bobera
- Brandon Charles Bodager
- David S Bogenschutz
- Anthony Bonfiglio
- Joshua Michael Bonis
All providers in Mequon, WI · Clinical Psychologist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 14, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.