Provider Demographics
NPI:1134318629
Name:FIEDLER, BLAINE (LMHC)
Entity Type:Individual
Prefix:MR
First Name:BLAINE
Middle Name:
Last Name:FIEDLER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 E 118TH ST
Mailing Address - Street 2:APT. 2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-4184
Mailing Address - Country:US
Mailing Address - Phone:917-526-3150
Mailing Address - Fax:
Practice Address - Street 1:216 E 118TH ST
Practice Address - Street 2:APT. 2B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4184
Practice Address - Country:US
Practice Address - Phone:917-526-3150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002199101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health