Healthcare Provider Details

I. General information

NPI: 1962531095
Provider Name (Legal Business Name): BLAIR S. GELBOND L.I.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1368 BEACON ST SUITE 108
BROOKLINE MA
02446-2872
US

IV. Provider business mailing address

12 CHISWICK RD APT. 1
BRIGHTON MA
02135-7102
US

V. Phone/Fax

Practice location:
  • Phone: 617-731-3240
  • Fax:
Mailing address:
  • Phone: 617-731-3240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105341
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: