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General NPI Number Information
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NPI Number | 1447728050
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Entity Type | Individual
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Provider Name | LAURELLE S BLAIR LISW
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Gender | Female
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 2041 MARTIN LUTHER KING JR AVE SE STE 234
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City | WASHINGTON
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State | DC
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Zip | 20020-7026
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Country | US
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Telephone | 202-610-0066
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Fax | 202-610-0669
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Provider Business Mailing Address
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Address Line | 2917 N CALVERT ST APT 1FR
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City | BALTIMORE
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State | MD
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Zip | 21218-4182
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Country | US
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Telephone | 202-352-5635
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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 | LC50081947
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License Number State | DC
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