Individual provider · Type 1 NPI
Jesse Samuel Goldblum
Psychiatric/Mental Health Nurse Practitioner · Hartford, CT
NPI number
1407637895
Active
Practice location
1680 Albany Ave
Hartford, CT 06105-1001
Mailing address
55 Marvel Rd Apt B2
New Haven, CT 06515-2169
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Registered Nurse | 163W00000X | 196780 (CT) |
| Psychiatric/Mental Health Nurse Practitioner Primary | 363LP0808X | 13775 (CT) |
Psychiatric/Mental Health Nurse Practitioner: Definition to come...
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About NPI 1407637895
Jesse Samuel Goldblum's National Provider Identifier is 1407637895, issued on Oct 11, 2023. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Hartford, CT. The record was last updated on Jan 4, 2025.