Provider Demographics
NPI:1346601788
Name:GOLDSMITH, BLAIR SKLUT (LCSW)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:SKLUT
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 LEIGH FARM RD
Mailing Address - Street 2:APT. 306
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-8130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:276 LEIGH FARM RD
Practice Address - Street 2:APT. 306
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-8130
Practice Address - Country:US
Practice Address - Phone:704-621-7756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-13
Last Update Date:2016-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0097751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical