Provider Demographics
NPI:1154503910
Name:BLASINI, YALISKA A (MA)
Entity Type:Individual
Prefix:MRS
First Name:YALISKA
Middle Name:A
Last Name:BLASINI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 BRIDGE ST
Mailing Address - Street 2:#1
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3930
Mailing Address - Country:US
Mailing Address - Phone:978-744-1585
Mailing Address - Fax:
Practice Address - Street 1:41 MASON ST
Practice Address - Street 2:UNIT # 4
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2260
Practice Address - Country:US
Practice Address - Phone:978-744-1585
Practice Address - Fax:978-744-1379
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH4669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health