Provider Demographics
NPI:1386368629
Name:BLYTHE, DEBORAH PATRICIA (MHC-LP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:PATRICIA
Last Name:BLYTHE
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 KELLY ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-4243
Mailing Address - Country:US
Mailing Address - Phone:347-375-0351
Mailing Address - Fax:
Practice Address - Street 1:944 KELLY ST APT 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-4243
Practice Address - Country:US
Practice Address - Phone:347-375-0351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP115383101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health