Provider Demographics
NPI:1659810927
Name:FRANKLIN, BLAIRE ALEXIS (LAC)
Entity Type:Individual
Prefix:MS
First Name:BLAIRE
Middle Name:ALEXIS
Last Name:FRANKLIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 W SAINT GEORGES AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-6167
Mailing Address - Country:US
Mailing Address - Phone:908-583-5151
Mailing Address - Fax:
Practice Address - Street 1:1203 W SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-6167
Practice Address - Country:US
Practice Address - Phone:908-583-5151
Practice Address - Fax:908-290-3105
Is Sole Proprietor?:No
Enumeration Date:2017-02-19
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00276600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health