Provider Demographics
NPI:1689751414
Name:BLAIR, KATHLEEN M (MASTER OF SOCIAL WOR)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MASTER OF SOCIAL WOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 DANBY RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5778
Mailing Address - Country:US
Mailing Address - Phone:607-260-3100
Mailing Address - Fax:
Practice Address - Street 1:950 DANBY RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5778
Practice Address - Country:US
Practice Address - Phone:607-260-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical