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General NPI Number Information
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NPI Number | 1336688944
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Entity Type | Organization
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Legal Business Name | JENNIFER BLAIR, L.C.S.W., LLC
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Dates
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Enumeration Date | 02/15/2017
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 107 CHURCH HILL RD
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City | SANDY HOOK
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State | CT
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Zip | 06482-1194
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Country | US
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Telephone | 203-592-9843
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Fax |
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Provider Business Mailing Address
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Address Line | 34 WOODSIDE AVE
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City | SEYMOUR
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State | CT
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Zip | 06483-2714
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | JENNIFER BLAIR
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Credential | LCSW
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Telephone | 203-592-9843
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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 | 005972
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License Number State | CT
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