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General NPI Number Information
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NPI Number | 1255708640
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Entity Type | Individual
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Provider Name | SUSAN BLAIR
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Gender | Female
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Dates
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Enumeration Date | 09/01/2015
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 2307 W 6TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90057-3119
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Country | US
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Telephone | 213-351-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 2271 ALPINE BLVD STE A
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City | ALPINE
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State | CA
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Zip | 91901-1101
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Country | US
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Telephone | 760-508-2882
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 101250
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License Number State | CA
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