MEDICARE: MS. MARCIA Z BLECKER NCPSYA, JD, MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	102L00000X	Psychoanalyst	000405	NY

General Provider Information

NPI Number	:	1134324767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCIA Z BLECKER NCPSYA, JD, MA

Provider Business Mailing Address
First Line	:	15 BAYBERRY RDG
Second Line	:
City	:	ROSLYN
State	:	NY
Zip	:	11576-1330
Country	:	US
Telephone Number	:	516-365-7180
Fax Number	:

Provider Business Practice Location Address
First Line	:	594 BROADWAY
Second Line	:	ALFRED ADLER INSTITUTE -- SUITE 1213
City	:	NEW YORK
State	:	NY
Zip	:	10012-3233
Country	:	US
Telephone Number	:	516-639-8490
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	07/08/2007

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