Provider Demographics
NPI:1588716583
Name:BLAIR, SHERRY A (LCSW)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:A
Last Name:BLAIR
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 1:216 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2926
Mailing Address - Country:US
Mailing Address - Phone:973-746-0333
Mailing Address - Fax:973-783-2464
Practice Address - Street 1:216 WALNUT STREET
Practice Address - Street 2:
Practice Address - City:MONTCLLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042
Practice Address - Country:US
Practice Address - Phone:973-746-0333
Practice Address - Fax:973-783-2464
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051882001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0032484Medicaid