Provider Demographics
NPI:1376610824
Name:BLAIR, JEAN MARIE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:MARIE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 W 22ND ST
Mailing Address - Street 2:#1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2525
Mailing Address - Country:US
Mailing Address - Phone:212-206-8560
Mailing Address - Fax:212-206-8077
Practice Address - Street 1:423 W 22ND ST
Practice Address - Street 2:#1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2525
Practice Address - Country:US
Practice Address - Phone:212-206-8560
Practice Address - Fax:212-206-8077
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054431104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker