Provider Demographics
NPI:1891916813
Name:BLOLAND, SUE ERIKSON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:ERIKSON
Last Name:BLOLAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:53 MAPLE AVENUE
Mailing Address - Street 2:APT 1B
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706-1417
Mailing Address - Country:US
Mailing Address - Phone:914-231-5548
Mailing Address - Fax:914-231-5548
Practice Address - Street 1:26 WEST 9TH STREET
Practice Address - Street 2:SUITE 9E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8920
Practice Address - Country:US
Practice Address - Phone:212-982-0275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070129-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP731042OtherOXFORD
NYP731042OtherOXFORD