Provider Demographics
NPI:1861101628
Name:BLATCHE, TYCHEL Y (BS BACHELOR'S DEGREE)
Entity type:Individual
Prefix:MS
First Name:TYCHEL
Middle Name:Y
Last Name:BLATCHE
Suffix:
Gender:F
Credentials:BS BACHELOR'S DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ALDEN ST # 2
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-1002
Mailing Address - Country:US
Mailing Address - Phone:860-328-1050
Mailing Address - Fax:
Practice Address - Street 1:48 SWORD ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2162
Practice Address - Country:US
Practice Address - Phone:508-368-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT860-328-1050Medicaid