Provider Demographics
NPI:1215226972
Name:BARONE, BLAIR W (MA, PSYD)
Entity Type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:W
Last Name:BARONE
Suffix:
Gender:F
Credentials:MA, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 N FEDERAL HWY
Mailing Address - Street 2:SUITE 122
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6035
Mailing Address - Country:US
Mailing Address - Phone:561-860-1404
Mailing Address - Fax:
Practice Address - Street 1:3200 N FEDERAL HWY
Practice Address - Street 2:SUITE 122
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6035
Practice Address - Country:US
Practice Address - Phone:561-860-1404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSYCHOLOGY - 7714103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent