Provider Demographics
NPI:1780798371
Name:BLAIR, SARAH MARIE (CASACT)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:MARIE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:CASACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W SOUTH ST
Mailing Address - Street 2:P.O. BOX 286
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-6524
Mailing Address - Country:US
Mailing Address - Phone:315-533-6506
Mailing Address - Fax:
Practice Address - Street 1:104 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-6524
Practice Address - Country:US
Practice Address - Phone:315-533-6506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18611101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY18611OtherCASACT