Provider Demographics
NPI:1104799600
Name:HESSE, BLAIR MICHELLE
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:MICHELLE
Last Name:HESSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ARPAGE DR W
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-3704
Mailing Address - Country:US
Mailing Address - Phone:631-578-6948
Mailing Address - Fax:
Practice Address - Street 1:400 W MAIN ST STE 340
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3009
Practice Address - Country:US
Practice Address - Phone:631-403-4719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128247-01101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor