Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 020486-1 | NY |
NPI | 1477159523 |
---|---|
Provider Name | Danielle Blair |
First Address | Brooklyn, NY 11218-4916 |
Second Address | New York, NY 10036-6925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2020 |
Last Update Date | 04/12/2020 |