Individual
MRS. BLAIR DIDIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
166 MAIN ST, MATAWAN, NJ 07747-3104
(732) 290-9040
Mailing address
45 HAWTHORNE DR, CLARK, NJ 07066-2820
(732) 540-4197
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
37AC00321200
NJ
Other
Enumeration date
05/23/2019
Last updated
05/23/2019
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