Provider Demographics
NPI:1558690941
Name:BLAHA, BETH DONOVAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:DONOVAN
Last Name:BLAHA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:BETH
Other - Middle Name:DONOVAN
Other - Last Name:STILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:61 ELMWOOD AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-3533
Mailing Address - Country:US
Mailing Address - Phone:518-221-6967
Mailing Address - Fax:518-834-7537
Practice Address - Street 1:4988 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7520
Practice Address - Country:US
Practice Address - Phone:518-843-7538
Practice Address - Fax:518-843-7537
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018615103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical