Healthcare Provider Details

I. General information

NPI: 1326075557
Provider Name (Legal Business Name): DENNIS JAMES BLAIR L.C.S.W.-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 CHANEYVILLE RD SUITE 102
OWINGS MD
20736-4319
US

IV. Provider business mailing address

PO BOX 630973
BALTIMORE MD
21263-0973
US

V. Phone/Fax

Practice location:
  • Phone: 410-286-0664
  • Fax: 410-286-2834
Mailing address:
  • Phone: 410-286-0664
  • Fax: 410-286-2834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number03914
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: