Provider Demographics
NPI:1578895603
Name:BLITZER, JULIANA
Entity Type:Individual
Prefix:MS
First Name:JULIANA
Middle Name:
Last Name:BLITZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 TERRACE VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-5079
Mailing Address - Country:US
Mailing Address - Phone:646-317-4206
Mailing Address - Fax:
Practice Address - Street 1:99 TERRACE VIEW AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5079
Practice Address - Country:US
Practice Address - Phone:646-317-4206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68020485103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical