Provider Demographics
NPI:1629714472
Name:BLASZCZYK, JENNY MARICELA (MS)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:MARICELA
Last Name:BLASZCZYK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E ATHENS AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2115
Mailing Address - Country:US
Mailing Address - Phone:267-838-0066
Mailing Address - Fax:
Practice Address - Street 1:10 E ATHENS AVE STE 214
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2115
Practice Address - Country:US
Practice Address - Phone:267-838-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health