Provider Demographics
NPI:1174553903
Name:BLUM, SASHA (PHD)
Entity type:Individual
Prefix:DR
First Name:SASHA
Middle Name:
Last Name:BLUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 DWIGHT WAY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2365
Mailing Address - Country:US
Mailing Address - Phone:510-604-1780
Mailing Address - Fax:
Practice Address - Street 1:2424 DWIGHT WAY
Practice Address - Street 2:SUITE 5
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2365
Practice Address - Country:US
Practice Address - Phone:510-604-1780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19253103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling