Provider Demographics
NPI:1053445940
Name:BLASKIEWICZ, AMY M (LMHC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:BLASKIEWICZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11904 LAUREL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-3711
Mailing Address - Country:US
Mailing Address - Phone:317-823-6712
Mailing Address - Fax:
Practice Address - Street 1:7526 E 82ND ST
Practice Address - Street 2:SUITE 150
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1461
Practice Address - Country:US
Practice Address - Phone:317-585-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000582101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health