Provider Demographics
NPI:1669190096
Name:TAUBENBLAT, MICHELE BETH (MS)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:BETH
Last Name:TAUBENBLAT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 W 186TH ST APT 5G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-8508
Mailing Address - Country:US
Mailing Address - Phone:917-940-4623
Mailing Address - Fax:
Practice Address - Street 1:729 W 186TH ST APT 5G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-8508
Practice Address - Country:US
Practice Address - Phone:917-940-4623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor