Provider Demographics
NPI:1538993464
Name:BLASINGAME, PATRICIA EUGENIA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:EUGENIA
Last Name:BLASINGAME
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 1:521 DREXEL AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-3844
Mailing Address - Country:US
Mailing Address - Phone:979-571-5718
Mailing Address - Fax:
Practice Address - Street 1:2288 2ND STREET PIKE STE 1
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-4108
Practice Address - Country:US
Practice Address - Phone:979-571-5718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health