Provider Demographics
NPI:1952390973
Name:BLOSTEIN, ROBIN J (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:J
Last Name:BLOSTEIN
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5544
Mailing Address - Country:US
Mailing Address - Phone:518-587-4161
Mailing Address - Fax:518-587-5134
Practice Address - Street 1:526 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5544
Practice Address - Country:US
Practice Address - Phone:518-587-4161
Practice Address - Fax:518-587-5134
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRP04413911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
145642OtherVO
7405658OtherEMPIRE ST NY PLAN GHI
335609OtherMHN TC
000471686001OtherBS NENY
394881OtherMVP
P90173Medicare UPIN
DD5802Medicare ID - Type Unspecified