Provider Demographics
NPI:1194213801
Name:FUCHS, BLAIRE ERICA (LCSW)
Entity Type:Individual
Prefix:
First Name:BLAIRE
Middle Name:ERICA
Last Name:FUCHS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 E LINDEN AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-1912
Mailing Address - Country:US
Mailing Address - Phone:201-577-2877
Mailing Address - Fax:
Practice Address - Street 1:76 S ORANGE AVE STE 209
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1923
Practice Address - Country:US
Practice Address - Phone:201-740-7137
Practice Address - Fax:973-378-9575
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086803-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0490512Medicaid