Provider Demographics
NPI:1144534496
Name:BLOM, INGA (PHD)
Entity type:Individual
Prefix:DR
First Name:INGA
Middle Name:
Last Name:BLOM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LEXINGTON AVE
Mailing Address - Street 2:SUITE LL3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2935
Mailing Address - Country:US
Mailing Address - Phone:646-522-9525
Mailing Address - Fax:
Practice Address - Street 1:50 LEXINGTON AVE
Practice Address - Street 2:SUITE LL3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2935
Practice Address - Country:US
Practice Address - Phone:646-522-9525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018776103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist