Provider Demographics
NPI:1639318157
Name:BLAIS, LYNDYL H (LCSW-C)
Entity Type:Individual
Prefix:
First Name:LYNDYL
Middle Name:H
Last Name:BLAIS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 RHAPSODY CT
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1915
Mailing Address - Country:US
Mailing Address - Phone:410-292-3010
Mailing Address - Fax:
Practice Address - Street 1:11350 MCCORMICK RD
Practice Address - Street 2:SUITE 408
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1002
Practice Address - Country:US
Practice Address - Phone:410-292-3010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD042521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical