Healthcare Provider Details

I. General information

NPI: 1598107179
Provider Name (Legal Business Name): CYNTHIA BLACKWELL MSW, M ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

921 NE 13TH ST
OKLAHOMA CITY OK
73104-5007
US

V. Phone/Fax

Practice location:
  • Phone: 405-465-1334
  • Fax: 405-456-1214
Mailing address:
  • Phone: 405-465-1334
  • Fax: 405-456-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5323
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: