Active NPI
Marideanne Blomgren, LPC
- Mental Health Counselor
- Kendall Park, NJ
National Provider Identifier
1528033040
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- PC 00003200
- Practice address
- 127 Andover Dr
Kendall Park, NJ 08824-7026 - Phone
- (732) 422-7669
- NPI assigned
- Feb 19, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | PC 00003200 | NJ | Primary |
Addresses
Primary practice location
127 Andover Dr
Kendall Park, NJ 08824-7026
Mailing address
127 Andover Dr
Kendall Park, NJ 08824-7026
Phone (732) 422-7669
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PC 00003200 | NJ | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352332800000",
"number": "1528033040",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "127 ANDOVER DR",
"city": "KENDALL PARK",
"state": "NJ",
"postal_code": "088247026",
"telephone_number": "732-422-7669"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "127 ANDOVER DR",
"city": "KENDALL PARK",
"state": "NJ",
"postal_code": "088247026",
"telephone_number": "732-422-7669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOMGREN",
"first_name": "MARIDEANNE",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-02-19",
"last_updated": "2012-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NJ",
"license": "PC 00003200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kendall Park, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.