Provider Demographics
NPI:1508572587
Name:BLUEPRINT WELLNESS INTERNATIONAL LLC
Entity Type:Organization
Organization Name:BLUEPRINT WELLNESS INTERNATIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RIORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:212-203-3118
Mailing Address - Street 1:50 SOLS POINT RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-2320
Mailing Address - Country:US
Mailing Address - Phone:212-203-3118
Mailing Address - Fax:
Practice Address - Street 1:50 SOLS POINT RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-2320
Practice Address - Country:US
Practice Address - Phone:212-203-3118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty