Provider Demographics
NPI:1366454233
Name:BLACKSTONE, JUDITH (LMHC)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:BLACKSTONE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-8209
Mailing Address - Country:US
Mailing Address - Phone:845-679-7005
Mailing Address - Fax:845-679-0278
Practice Address - Street 1:14 E 4TH ST
Practice Address - Street 2:C/O CAROL GLASSMAN, SUITE 407
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1155
Practice Address - Country:US
Practice Address - Phone:914-388-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health