Healthcare Provider Details

I. General information

NPI: 1760512289
Provider Name (Legal Business Name): CARRIE ANN BLANCHARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HOLLAND AVE
ALBANY NY
12208-3410
US

IV. Provider business mailing address

113 HOLLAND AVE
ALBANY NY
12208-3410
US

V. Phone/Fax

Practice location:
  • Phone: 518-626-5157
  • Fax:
Mailing address:
  • Phone: 518-626-5157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR054919-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: