Provider Demographics
NPI:1891042875
Name:BLAIR, ERNETTA TRAVIS (MSW,LSW)
Entity Type:Individual
Prefix:
First Name:ERNETTA
Middle Name:TRAVIS
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MSW,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 WESLEY AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2244
Mailing Address - Country:US
Mailing Address - Phone:513-929-0020
Mailing Address - Fax:513-929-0014
Practice Address - Street 1:4750 WESLEY AVE
Practice Address - Street 2:SUITE J
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2244
Practice Address - Country:US
Practice Address - Phone:513-929-0020
Practice Address - Fax:513-929-0014
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0031099104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker