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General NPI Number Information
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NPI Number | 1861102907
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Entity Type | Organization
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Legal Business Name | BUTTERFLIES BY BLAQ INC.
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Dates
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Enumeration Date | 11/30/2022
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 11569 FARMERS BLVD
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City | SAINT ALBANS
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State | NY
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Zip | 11412-3022
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Country | US
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Telephone | 718-978-2527
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Fax | 718-978-2528
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Provider Business Mailing Address
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Address Line | 11569 FARMERS BLVD
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City | SAINT ALBANS
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State | NY
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Zip | 11412-3022
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Country | US
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Telephone | 718-978-2527
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Fax | 718-978-2528
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Authorized Official
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Title or Position | FOUNDER
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Name | ERNA BLACKMAN
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Credential |
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Telephone | 718-978-2527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 364SP0810X
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Taxonomy Name | Child & Family Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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