MEDICARE: MS. JENNIFER RUIZ BLANDON LCSW

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	1041C0700X	Clinical Social Worker	086460-01	NY
2	104100000X	Social Worker	083550	NY

General Provider Information

NPI Number	:	1821398454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER RUIZ BLANDON LCSW

Provider Business Mailing Address
First Line	:	75 S. BROADWAY
Second Line	:	4TH FLOOR SUITE 1018
City	:	WHITE PLAINS
State	:	NY
Zip	:	10601-4413
Country	:	US
Telephone Number	:	914-402-9300
Fax Number	:	914-237-6099

Provider Business Practice Location Address
First Line	:	443 MAIN ST
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10601-3605
Country	:	US
Telephone Number	:	914-402-9300
Fax Number	:

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

Provider Enumeration Date	:	10/29/2010
Last Update Date	:	01/05/2023

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