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Individual

GARY APPLEBY BLONSKY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
1100 N UNIVERSITY AVE, LITTLE ROCK, AR 72207-6343
(501) 773-0290
Mailing address
3601 LAKESHORE DR, NORTH LITTLE ROCK, AR 72116-9053
(501) 773-0290

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
565-C
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12345
BLUE CROSS BLUE SHIELD
AR
Enumeration date
01/29/2020
Last updated
01/29/2020
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