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General NPI Number Information
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NPI Number | 1790029601
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Entity Type | Individual
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Provider Name | GEORGE LEO BLANDFORD
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Gender | Male
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 49 HARRY KEMP WAY
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City | PROVINCETOWN
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State | MA
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Zip | 02657-1618
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Country | US
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Telephone | 508-487-9395
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 598
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City | HARWICH PORT
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State | MA
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Zip | 02646-0598
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Country | US
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Telephone | 508-905-2800
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Fax | 508-240-0499
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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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 | 221172
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License Number State | MA
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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 | 120994
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License Number State | MA
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