Provider Demographics
NPI:1164596847
Name:BLUESTEIN, ELAINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:
Last Name:BLUESTEIN
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 1:52 BEACH RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824
Mailing Address - Country:US
Mailing Address - Phone:203-254-2000
Mailing Address - Fax:203-255-3126
Practice Address - Street 1:52 BEACH RD
Practice Address - Street 2:SUITE 104
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824
Practice Address - Country:US
Practice Address - Phone:203-254-2000
Practice Address - Fax:203-255-3126
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0004181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1272864Medicaid
800001351Medicare ID - Type Unspecified