Provider Demographics
NPI:1417216565
Name:BLODGET, KATHARINE CHANDLER (LMSW)
Entity type:Individual
Prefix:MS
First Name:KATHARINE
Middle Name:CHANDLER
Last Name:BLODGET
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 E 78TH ST
Mailing Address - Street 2:#18
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1672
Mailing Address - Country:US
Mailing Address - Phone:646-701-2454
Mailing Address - Fax:
Practice Address - Street 1:446 E 78TH ST
Practice Address - Street 2:#18
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1672
Practice Address - Country:US
Practice Address - Phone:646-701-2454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085987-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker