Provider Demographics
NPI:1437906229
Name:BLUMENKOPF, LAINE ALEXANDRA (LMSW)
Entity type:Individual
Prefix:
First Name:LAINE
Middle Name:ALEXANDRA
Last Name:BLUMENKOPF
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MIANUS VIEW TER
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2219
Mailing Address - Country:US
Mailing Address - Phone:561-542-1544
Mailing Address - Fax:
Practice Address - Street 1:590 POST RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-3608
Practice Address - Country:US
Practice Address - Phone:203-443-8095
Practice Address - Fax:203-443-8095
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6741104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker