Provider Demographics
NPI:1881963395
Name:BLOOD, NATHANIEL (LMSW)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:BLOOD
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 WESTAGE AT THE HBR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-1015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:919 WINTON RD S
Practice Address - Street 2:110
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-1633
Practice Address - Country:US
Practice Address - Phone:585-270-4164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083670104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker