Provider Demographics
NPI:1114075884
Name:BLAIR, DAVID ALLEN (MSW, LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLEN
Last Name:BLAIR
Suffix:
Gender:M
Credentials:MSW, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WESTLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-3723
Mailing Address - Country:US
Mailing Address - Phone:315-258-7147
Mailing Address - Fax:
Practice Address - Street 1:146 NORTH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1831
Practice Address - Country:US
Practice Address - Phone:315-253-2746
Practice Address - Fax:315-253-1077
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR022267-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53174BMedicare ID - Type Unspecified