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General NPI Number Information
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NPI Number | 1699137950
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Entity Type | Individual
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Provider Name | JEANNINE BLACKWELL LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/25/2016
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Last Update Date | 03/25/2016
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Provider Practice Location Address
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Address Line | 14527 7TH ST
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City | DADE CITY
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State | FL
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Zip | 33523-3102
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Country | US
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Telephone | 352-345-1235
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Fax |
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Provider Business Mailing Address
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Address Line | 27221 STATE ROAD 56 # 139
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-8832
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Country | US
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Telephone | 352-345-1235
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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 | SW 13385
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License Number State | FL
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