MEDICARE: CHANTAE BLOUNT LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	102432	NY

General Provider Information

NPI Number	:	1780200642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANTAE BLOUNT LCSW

Provider Business Mailing Address
First Line	:	150 WALRATH RD
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13205-1825
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4949 VELASKO RD
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13215-1930
Country	:	US
Telephone Number	:	800-245-7277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2020
Last Update Date	:	03/31/2026

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