Provider Demographics
NPI:1154339307
Name:BLAUFARB, JONATHAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:BLAUFARB
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 14TH ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-8212
Mailing Address - Country:US
Mailing Address - Phone:718-965-1771
Mailing Address - Fax:
Practice Address - Street 1:641 PRESIDENT ST APT 107
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1186
Practice Address - Country:US
Practice Address - Phone:917-304-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077604-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400032694Medicare PIN