Provider Demographics
NPI:1962531095
Name:GELBOND, BLAIR S (LICSW)
Entity type:Individual
Prefix:MR
First Name:BLAIR
Middle Name:S
Last Name:GELBOND
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CHISWICK RD
Mailing Address - Street 2:APT. 1
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7102
Mailing Address - Country:US
Mailing Address - Phone:617-731-3240
Mailing Address - Fax:
Practice Address - Street 1:1368 BEACON ST
Practice Address - Street 2:SUITE 108
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2872
Practice Address - Country:US
Practice Address - Phone:617-731-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1053411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical