Provider Demographics
NPI:1609343441
Name:LOUIS BLASETTI LLC
Entity Type:Organization
Organization Name:LOUIS BLASETTI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:BLASETTI
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-732-5609
Mailing Address - Street 1:212 S CONKLING ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2413
Mailing Address - Country:US
Mailing Address - Phone:443-854-0147
Mailing Address - Fax:
Practice Address - Street 1:3400 CHESTNUT AVE FL 2
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2516
Practice Address - Country:US
Practice Address - Phone:443-732-5609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health