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General NPI Number Information
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NPI Number | 1366454233
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Entity Type | Individual
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Provider Name | JUDITH BLACKSTONE LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 14 E 4TH ST C/O CAROL GLASSMAN, SUITE 407
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City | NEW YORK
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State | NY
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Zip | 10012-1155
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Country | US
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Telephone | 914-388-4714
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1209
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City | WOODSTOCK
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State | NY
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Zip | 12498-8209
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Country | US
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Telephone | 845-679-7005
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Fax | 845-679-0278
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 000388
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License Number State | NY
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