Provider Demographics
NPI:1306718374
Name:BLACKHAM, JENNY MARIE (MHC-LP)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:MARIE
Last Name:BLACKHAM
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SCHOLES ST APT A1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-2257
Mailing Address - Country:US
Mailing Address - Phone:719-352-5158
Mailing Address - Fax:
Practice Address - Street 1:210 SCHOLES ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-2276
Practice Address - Country:US
Practice Address - Phone:719-352-5158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP131657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health