Provider Demographics
NPI:1912637000
Name:BLACKWELL, SAHNTANYNA NATE
Entity Type:Individual
Prefix:
First Name:SAHNTANYNA
Middle Name:NATE
Last Name:BLACKWELL
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 1:674 GRANT TER
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-6521
Mailing Address - Country:US
Mailing Address - Phone:917-822-9534
Mailing Address - Fax:201-836-0544
Practice Address - Street 1:674 GRANT TER
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-6521
Practice Address - Country:US
Practice Address - Phone:917-822-9534
Practice Address - Fax:201-836-0544
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012257101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty