Provider Demographics
NPI:1366868937
Name:BLAIR, JUDITH C (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:C
Last Name:BLAIR
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 1:112 LAFAYETTE CT
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-1491
Mailing Address - Country:US
Mailing Address - Phone:732-303-1031
Mailing Address - Fax:
Practice Address - Street 1:112 LAFAYETTE CT
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-1491
Practice Address - Country:US
Practice Address - Phone:732-303-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC005906001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical