Provider Demographics
NPI:1528033040
Name:BLOMGREN, MARIDEANNE (LPC)
Entity Type:Individual
Prefix:
First Name:MARIDEANNE
Middle Name:
Last Name:BLOMGREN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 ANDOVER DR
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-7026
Mailing Address - Country:US
Mailing Address - Phone:732-422-7669
Mailing Address - Fax:
Practice Address - Street 1:127 ANDOVER DR
Practice Address - Street 2:
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-7026
Practice Address - Country:US
Practice Address - Phone:732-422-7669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-19
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPC 00003200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health