Provider Demographics
NPI:1740425974
Name:BLANTON-PEALE INSTITUTE
Entity Type:Organization
Organization Name:BLANTON-PEALE INSTITUTE
Other - Org Name:BLANTON-PEALE COUNSELING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR COMMUNITY COUNSELING CENTE
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:PATER-ENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:212-725-7850
Mailing Address - Street 1:3 WEST 29TH STREET
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001
Mailing Address - Country:US
Mailing Address - Phone:212-725-7850
Mailing Address - Fax:212-689-3212
Practice Address - Street 1:39-50 DOUGLASTON PARKWAY
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11363
Practice Address - Country:US
Practice Address - Phone:212-725-7850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058972-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty