Provider Demographics
NPI:1760224554
Name:BERLIN, BLAIR ALEXANDRA (MSW)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:ALEXANDRA
Last Name:BERLIN
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 1:950 S OYSTER BAY RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3511
Mailing Address - Country:US
Mailing Address - Phone:516-396-2703
Mailing Address - Fax:
Practice Address - Street 1:39 RUSTIC GATE LN
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6137
Practice Address - Country:US
Practice Address - Phone:631-804-4413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program