Provider Demographics
NPI:1215028154
Name:BLACKSTEIN, NEAL MARTIN (DCH, PD, MS)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:MARTIN
Last Name:BLACKSTEIN
Suffix:
Gender:M
Credentials:DCH, PD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 THORNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3412
Mailing Address - Country:US
Mailing Address - Phone:845-268-2802
Mailing Address - Fax:
Practice Address - Street 1:472 KINGS HWY
Practice Address - Street 2:CENTER FOR PERSONAL GROWTH,
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-1439
Practice Address - Country:US
Practice Address - Phone:845-268-2802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000315101YM0800X
CT000371101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional