Provider Demographics
NPI:1558659037
Name:BLY, EMILY (PHD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:BLY
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 1:400-410 KING ST
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-3500
Mailing Address - Country:US
Mailing Address - Phone:347-560-4628
Mailing Address - Fax:914-873-1106
Practice Address - Street 1:400 KING ST STE 7
Practice Address - Street 2:
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514-3500
Practice Address - Country:US
Practice Address - Phone:347-560-4628
Practice Address - Fax:914-873-1106
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019170103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical