Provider Demographics
NPI:1154468452
Name:BLECKNER, SHEILA K (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:K
Last Name:BLECKNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 W END AVE
Mailing Address - Street 2:11E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5503
Mailing Address - Country:US
Mailing Address - Phone:212-787-2603
Mailing Address - Fax:212-787-2603
Practice Address - Street 1:30 W 63RD ST
Practice Address - Street 2:SUITE 8L
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7103
Practice Address - Country:US
Practice Address - Phone:212-245-2343
Practice Address - Fax:212-787-2603
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO150051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical