Provider Demographics
NPI:1275316135
Name:BLAYNE, PAIGE ALLEGRA
Entity Type:Individual
Prefix:MISS
First Name:PAIGE
Middle Name:ALLEGRA
Last Name:BLAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 SPRUCE LN
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-3745
Mailing Address - Country:US
Mailing Address - Phone:917-562-9653
Mailing Address - Fax:
Practice Address - Street 1:1115 BROADWAY FL 10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3454
Practice Address - Country:US
Practice Address - Phone:646-397-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health