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General NPI Number Information
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NPI Number | 1366536641
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Entity Type | Individual
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Provider Name | DELORES BLACKWELL LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 12/21/2010
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Provider Practice Location Address
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Address Line | 2265 5TH AVENUE APT MH
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City | NEW YORK
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State | NY
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Zip | 10037
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Country | US
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Telephone | 917-445-2023
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Fax |
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Provider Business Mailing Address
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Address Line | 2265 5TH AVE APT MH
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City | NEW YORK
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State | NY
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Zip | 10037-2019
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 069826
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13399
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C006651
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW9004313
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License Number State | GA
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