Individual
KIMBERLY BLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHC-LP
Contact information
Practice address
1444 5TH AVE, BAY SHORE, NY 11706-4147
(631) 647-3100
Mailing address
1479 E 3RD AVE, BAY SHORE, NY 11706-3023
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
P119976
NY
Other
Enumeration date
05/03/2023
Last updated
05/03/2023
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