Provider Demographics
NPI:1902206345
Name:BLAIR, COLIN THOMAS (MSW)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:THOMAS
Last Name:BLAIR
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 SUFFOLK ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-4458
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:94 SUFFOLK ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-4458
Practice Address - Country:US
Practice Address - Phone:413-315-3184
Practice Address - Fax:413-322-8404
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2201151041C0700X
NY0923831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical