Provider Demographics
NPI:1447491154
Name:BLUMROSEN, DANIEL (MA MFT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BLUMROSEN
Suffix:
Gender:M
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 WOOLSEY ST # 1
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2524
Mailing Address - Country:US
Mailing Address - Phone:510-929-1065
Mailing Address - Fax:
Practice Address - Street 1:2315 PRINCE ST # 7
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1915
Practice Address - Country:US
Practice Address - Phone:510-929-1065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44056106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health