Raydale Blaylock, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

086857 Issued in NY

Practice address

116 W 23Rd St FL 5
New York, NY 10011-2599

Phone

(212) 729-6034

NPI assigned

Oct 22, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1184223950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 W 23RD ST FL 5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100112599",
            "telephone_number": "212-729-6034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 W 23RD ST FL 5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100112599",
            "telephone_number": "212-729-6034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAYLOCK",
        "first_name": "RAYDALE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-22",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "086857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven H Blaustein, PHD
• Stuart Blaustein, DMD
• Blauvelt Quality Care Physical Therapy PC
• Gabriela Blay, MD
• Livia Blaylock
• Paige Allegra Blayne
• Alicia Blazejewski, MD
• Sanja Blazekovic, LMSW
• Ashira D. Blazer, M.D.
• Saysha M Blazier, O.D.

• Clinical Social Worker in New York, NY
• Providers in New York, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.