Provider Demographics
NPI:1316579238
Name:BLUE HARBOR PSYCHOTHERAPY LCSW, PLLC
Entity Type:Organization
Organization Name:BLUE HARBOR PSYCHOTHERAPY LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:FIDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:646-470-1891
Mailing Address - Street 1:112 W 34TH ST FL 17
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10120-0001
Mailing Address - Country:US
Mailing Address - Phone:646-470-1891
Mailing Address - Fax:718-744-9755
Practice Address - Street 1:112 W 34TH ST FL 17
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10120-0001
Practice Address - Country:US
Practice Address - Phone:646-470-1891
Practice Address - Fax:718-744-9755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty