Healthcare Provider Details

I. General information

NPI: 1104738277
Provider Name (Legal Business Name): PAOLA CHAMBERLAIN BLOISE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 BROADWAY STE 2112
NEW YORK NY
10018-9228
US

IV. Provider business mailing address

606 W 30TH ST APT 32J
NEW YORK NY
10001-0637
US

V. Phone/Fax

Practice location:
  • Phone: 917-969-2445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: