Basic Information
| Provider Information | |||||||||
| NPI: | 1124169743 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLITZER | ||||||||
| FirstName: | MELINDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 CARPENTER PL | ||||||||
| Address2: | |||||||||
| City: | SEA CLIFF | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115792103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163532513 | ||||||||
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| Practice Location | |||||||||
| Address1: | 910 W END AVE | ||||||||
| Address2: | 1C | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100253533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128518100 | ||||||||
| FaxNumber: | 2129320964 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 016956 | NY | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.