Provider Demographics
NPI:1013808922
Name:BLAYLOCK, TESS (MSW)
Entity type:Individual
Prefix:
First Name:TESS
Middle Name:
Last Name:BLAYLOCK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 COLUMBIA RD APT 7F
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-4017
Mailing Address - Country:US
Mailing Address - Phone:301-633-8679
Mailing Address - Fax:301-633-8679
Practice Address - Street 1:1968 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-1410
Practice Address - Country:US
Practice Address - Phone:781-449-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health