Healthcare Provider Details

I. General information

NPI: 1720429111
Provider Name (Legal Business Name): KEVIN MICHAEL BLOMFIELD LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 BELL ST
HIAWASSEE GA
30546-2318
US

IV. Provider business mailing address

214 BELL ST
HIAWASSEE GA
30546-2318
US

V. Phone/Fax

Practice location:
  • Phone: 239-888-7321
  • Fax:
Mailing address:
  • Phone: 239-888-7321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18245
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: