Healthcare Provider Details

I. General information

NPI: 1790365948
Provider Name (Legal Business Name): SUZANNE PAIGE BLACHARSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SCHOOL ST STE 302
GLEN COVE NY
11542-2548
US

IV. Provider business mailing address

3 SCHOOL ST STE 302
GLEN COVE NY
11542-2548
US

V. Phone/Fax

Practice location:
  • Phone: 516-759-1234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number099693
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: