Provider Demographics
NPI:1184735557
Name:BLAIR, A. LINDA (MSW, LCSW, BCD, QCSW)
Entity type:Individual
Prefix:
First Name:A.
Middle Name:LINDA
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MSW, LCSW, BCD, QCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 JACQUELINE DR
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1715
Mailing Address - Country:US
Mailing Address - Phone:610-647-2799
Mailing Address - Fax:
Practice Address - Street 1:29 JACQUELINE DR
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1715
Practice Address - Country:US
Practice Address - Phone:610-647-2799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW010434L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0534168000OtherIBC
PA229847000OtherKEYSTONE
PA7382104OtherAETNA
PA033877Medicare Oscar/Certification