Provider Demographics
NPI:1689703332
Name:BLAZAK, PAIGE GAYLE (LMHC, NCC, CASAC)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:GAYLE
Last Name:BLAZAK
Suffix:
Gender:F
Credentials:LMHC, NCC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-8882
Mailing Address - Country:US
Mailing Address - Phone:585-750-4772
Mailing Address - Fax:
Practice Address - Street 1:13 TERRACE DR
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-8882
Practice Address - Country:US
Practice Address - Phone:585-750-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3551101YA0400X
NY000357101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)