Provider Demographics
NPI:1225195787
Name:BLANTON-PEALE INSTITUTE
Entity Type:Organization
Organization Name:BLANTON-PEALE INSTITUTE
Other - Org Name:BLANTON-PEALE COUNSELING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:KENNEDY
Authorized Official - Last Name:SPRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:212-725-7850
Mailing Address - Street 1:7 WEST 30TH STREET
Mailing Address - Street 2:9TH & 10TH FLOOR
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10001
Mailing Address - Country:US
Mailing Address - Phone:212-725-7850
Mailing Address - Fax:212-967-4919
Practice Address - Street 1:7 WEST 30TH STREET
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:212-725-7850
Practice Address - Fax:212-967-4919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6673100A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244720Medicaid
NYW02191Medicare PIN
NY00244720Medicaid