Provider Demographics
NPI:1083081780
Name:LORD, BLAIR EVANS (LCSW)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:EVANS
Last Name:LORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BLAIR
Other - Middle Name:EVANS
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:850 COLORADO BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1733
Mailing Address - Country:US
Mailing Address - Phone:213-915-8621
Mailing Address - Fax:
Practice Address - Street 1:850 COLORADO BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1733
Practice Address - Country:US
Practice Address - Phone:213-915-8621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA661551041C0700X
CALCSW661551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical