Provider Demographics
NPI:1518632561
Name:BLAUSTEIN, TOVA (LBA)
Entity type:Individual
Prefix:MRS
First Name:TOVA
Middle Name:
Last Name:BLAUSTEIN
Suffix:
Gender:F
Credentials:LBA
Other - Prefix:
Other - First Name:TOVA
Other - Middle Name:
Other - Last Name:HECHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1504 E 37TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1504 E 37TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2706
Practice Address - Country:US
Practice Address - Phone:347-403-2855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2024-06-03
Deactivation Date:2024-03-12
Deactivation Code:
Reactivation Date:2024-06-03
Provider Licenses
StateLicense IDTaxonomies
NY003547103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst