=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407776099
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIE JOELLE BLACKMAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2026
-----------------------------------------------------
Last Update Date | 07/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1919 HAZEN ST
-----------------------------------------------------
City | EAST ELMHURST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11370-1210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-809-2388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 449 STANLEY PL
-----------------------------------------------------
City | RAHWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07065-2519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-809-2388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 016664
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------