Provider Demographics
NPI:1578204137
Name:BISHER, BLAIR PATTON (MHA, PMP)
Entity Type:Individual
Prefix:PROF
First Name:BLAIR
Middle Name:PATTON
Last Name:BISHER
Suffix:
Gender:M
Credentials:MHA, PMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 NEEDHAM ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-1438
Mailing Address - Country:US
Mailing Address - Phone:617-935-6570
Mailing Address - Fax:
Practice Address - Street 1:53 NEEDHAM ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-1438
Practice Address - Country:US
Practice Address - Phone:617-935-6570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral