Healthcare Provider Details

I. General information

NPI: 1821277112
Provider Name (Legal Business Name): SAMANTHA BELLA BLACKWELL MSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDA RACHELLE GORDON MSW, LISW

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 E ERIE AVE
LORAIN OH
44052-2142
US

IV. Provider business mailing address

1053 E ERIE AVE
LORAIN OH
44052-2142
US

V. Phone/Fax

Practice location:
  • Phone: 440-240-3975
  • Fax:
Mailing address:
  • Phone: 440-240-3975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-21963
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL14937
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1000111-SUPV
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11209-C
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904015800
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: