Provider Demographics
NPI:1023357001
Name:BLEYKHMAN, INNA (MSW)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:BLEYKHMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4505
Mailing Address - Country:US
Mailing Address - Phone:415-516-1759
Mailing Address - Fax:415-355-7408
Practice Address - Street 1:101 GROVE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4505
Practice Address - Country:US
Practice Address - Phone:415-516-1759
Practice Address - Fax:415-355-7408
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33193101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor