Provider Demographics
NPI:1639160252
Name:BLANKSCHEN, MICHAEL PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
Last Name:BLANKSCHEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 WALL ST
Mailing Address - Street 2:2-A
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3849
Mailing Address - Country:US
Mailing Address - Phone:845-338-7478
Mailing Address - Fax:845-338-7478
Practice Address - Street 1:318 WALL ST
Practice Address - Street 2:SUITE 3-A
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-8003
Practice Address - Country:US
Practice Address - Phone:845-338-7478
Practice Address - Fax:845-338-7478
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012795103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01671585Medicaid
NY01671585Medicaid