Provider Demographics
NPI:1962912576
Name:BLAIS, ANDREA MARGUERITE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARGUERITE
Last Name:BLAIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARGUERITE
Other - Last Name:BLAIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:1 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3960
Mailing Address - Country:US
Mailing Address - Phone:508-884-8855
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3960
Practice Address - Country:US
Practice Address - Phone:508-828-9116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health