Provider Demographics
NPI:1912217845
Name:BLUE, CECELIA
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:
Last Name:BLUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20247
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87154-0247
Mailing Address - Country:US
Mailing Address - Phone:312-339-2221
Mailing Address - Fax:
Practice Address - Street 1:500 SPRING RD
Practice Address - Street 2:275
Practice Address - City:INGLESIDE
Practice Address - State:IL
Practice Address - Zip Code:60041-0275
Practice Address - Country:US
Practice Address - Phone:312-339-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor