Kathleen M Blair, MASTER OF SOCIAL WOR

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

950 Danby Rd
Ithaca, NY 14850-5778

Phone

(607) 260-3100

NPI assigned

Nov 1, 2006

Last updated

Jun 10, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Dec 8, 2022 through Dec 8, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mindwell Psychology, LLP

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ithaca, NY
  • NPI 1255944377
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623283200000",
    "number": "1689751414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 DANBY RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148505778",
            "telephone_number": "607-260-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 DANBY RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148505778",
            "telephone_number": "607-260-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAIR",
        "first_name": "KATHLEEN",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "MASTER OF SOCIAL WOR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theoneste Bizimana, LMHC
• BJ's Wholesale Club Inc.
• Karen Anne Black, OTR/L
• Jacob E. Blaine, MS, PT
• Emily L Blair
• Deidre Blake, M.D.
• Alison Bliss
• Althea Blodgett-Gallahan, RN, CNM
• Katrina Blomquist, PH.D.
• Joseph Blood, PAC

• Clinical Social Worker in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.