Provider Demographics
NPI:1215641923
Name:BLANCHARD, KATHERINE ASHLEY
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ASHLEY
Last Name:BLANCHARD
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 1:320 S HARRISON ST APT 3O
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1311
Mailing Address - Country:US
Mailing Address - Phone:908-917-3249
Mailing Address - Fax:
Practice Address - Street 1:570 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1308
Practice Address - Country:US
Practice Address - Phone:973-450-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05957200104100000X
NY090357104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker