Provider Demographics
NPI:1356473219
Name:BLAKELY-KOMAR, SALLY LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:LYNN
Last Name:BLAKELY-KOMAR
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 1:10 HUNTS MILL RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-1360
Mailing Address - Country:US
Mailing Address - Phone:908-703-8138
Mailing Address - Fax:908-730-8139
Practice Address - Street 1:10 HUNTS MILL RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-1360
Practice Address - Country:US
Practice Address - Phone:908-703-8138
Practice Address - Fax:908-730-8139
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC045942001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical