Individual
CARISSA BLASIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
139 MAIN ST # C, STONY BROOK, NY 11790-1944
(631) 875-5979
Mailing address
PO BOX 1303, STONY BROOK, NY 11790-0908
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0700391
NY
Other
Enumeration date
03/07/2017
Last updated
03/07/2017
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