Basic Information
| Provider Information | |||||||||
| NPI: | 1164596847 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLUESTEIN | ||||||||
| FirstName: | ELAINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 52 BEACH RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032542000 | ||||||||
| FaxNumber: | 2032553126 | ||||||||
| Practice Location | |||||||||
| Address1: | 52 BEACH RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032542000 | ||||||||
| FaxNumber: | 2032553126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 09/29/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 000418 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1272864 | 05 | CT | MEDICAID |