Healthcare Provider Details

I. General information

NPI: 1184735557
Provider Name (Legal Business Name): A. LINDA BLAIR MSW, LCSW, BCD, QCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 JACQUELINE DR
PAOLI PA
19301-1715
US

IV. Provider business mailing address

29 JACQUELINE DR
PAOLI PA
19301-1715
US

V. Phone/Fax

Practice location:
  • Phone: 610-647-2799
  • Fax:
Mailing address:
  • Phone: 610-647-2799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCW010434L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: