Provider Demographics
NPI:1821398454
Name:BLANDON, JENNIFER RUIZ (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:RUIZ
Last Name:BLANDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 S. BROADWAY
Mailing Address - Street 2:4TH FLOOR SUITE 1018
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4413
Mailing Address - Country:US
Mailing Address - Phone:914-402-9300
Mailing Address - Fax:914-237-6099
Practice Address - Street 1:443 MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-3605
Practice Address - Country:US
Practice Address - Phone:914-402-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086460-011041C0700X
NY083550104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker