Provider Demographics
NPI:1457685430
Name:BLAIR, WENDY (LCSW-R)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 S MANHEIM BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-2406
Mailing Address - Country:US
Mailing Address - Phone:845-661-8054
Mailing Address - Fax:
Practice Address - Street 1:52 S MANHEIM BLVD
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-2406
Practice Address - Country:US
Practice Address - Phone:845-661-8054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0189971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR018997OtherLICENSE