Healthcare Provider Details

I. General information

NPI: 1144503335
Provider Name (Legal Business Name): BLAIR COWPERTHWAITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 02/21/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 MAIN ST APT A
MARTINEZ CA
94553-1121
US

IV. Provider business mailing address

5674 STONERIDGE DR STE 207
PLEASANTON CA
94588-8592
US

V. Phone/Fax

Practice location:
  • Phone: 510-559-0148
  • Fax:
Mailing address:
  • Phone: 925-520-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number119151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: