Healthcare Provider Details

I. General information

NPI: 1922123702
Provider Name (Legal Business Name): DAVID BLACKBURN LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 ELKRIDGE LANDING RD STE 350
LINTHICUM MD
21090-2909
US

IV. Provider business mailing address

939 ELKRIDGE LANDING RD STE 350
LINTHICUM MD
21090-2909
US

V. Phone/Fax

Practice location:
  • Phone: 443-354-8903
  • Fax: 443-410-0663
Mailing address:
  • Phone: 443-354-8903
  • Fax: 443-410-0643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number04114
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: