Provider Demographics
NPI:1427390020
Name:BLAIR, LAURA (LSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 N CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-7019
Mailing Address - Country:US
Mailing Address - Phone:814-445-1717
Mailing Address - Fax:814-445-1885
Practice Address - Street 1:1590 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-7019
Practice Address - Country:US
Practice Address - Phone:814-445-1717
Practice Address - Fax:814-445-1885
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130255104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker