Basic Information
| Provider Information | |||||||||
| NPI: | 1407400435 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLOMSTEDT | ||||||||
| FirstName: | SANDRINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 E 3RD ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100039003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3473459489 | ||||||||
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| Practice Location | |||||||||
| Address1: | 184 ELDRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100022992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126749120 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2019 | ||||||||
| LastUpdateDate: | 07/29/2019 | ||||||||
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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 | 172V00000X | N | Other Service Providers | Community Health Worker | 101YM0800X | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.