Healthcare Provider Details

I. General information

NPI: 1104799600
Provider Name (Legal Business Name): BLAIR MICHELLE HESSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 ARPAGE DR W
SHIRLEY NY
11967-3704
US

IV. Provider business mailing address

6 ARPAGE DR W
SHIRLEY NY
11967-3704
US

V. Phone/Fax

Practice location:
  • Phone: 631-578-6948
  • Fax:
Mailing address:
  • Phone: 631-578-6948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number128247-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number128247-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: