Provider Demographics
NPI:1487787552
Name:BLASIAK, MIRIAM LERER
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:LERER
Last Name:BLASIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIMI
Other - Middle Name:LERER
Other - Last Name:BLASIAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14312 CARTWRIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-4809
Mailing Address - Country:US
Mailing Address - Phone:301-279-5443
Mailing Address - Fax:
Practice Address - Street 1:5028 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 400
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4118
Practice Address - Country:US
Practice Address - Phone:202-537-6050
Practice Address - Fax:202-237-2730
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC30007811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical