Provider Demographics
NPI:1821370388
Name:BLAIR, RIMA (PHD)
Entity Type:Individual
Prefix:DR
First Name:RIMA
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 WASHINGTON STREET
Mailing Address - Street 2:APT GA
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-2862
Mailing Address - Country:US
Mailing Address - Phone:212-243-5483
Mailing Address - Fax:
Practice Address - Street 1:26 WEST 9TH ST.
Practice Address - Street 2:#8C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8971
Practice Address - Country:US
Practice Address - Phone:212-243-5483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS4930103TC0700X
NY4930103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical