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NPI Code Detail

MEDICARE: AMIE BLACKBURN LCSW

MEDICARE:   AMIE  BLACKBURN  LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker11723LA

General Provider Information

NPI Number : 1053709063
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMIE BLACKBURN LCSW
Provider Business Mailing Address
First Line : 3353 UNIVERSITY PKWY
Second Line :
City : LEESVILLE
State : LA
Zip : 71446-9041
Country : US
Telephone Number : 337-392-3800
Fax Number :
Provider Business Practice Location Address
First Line : 3353 UNIVERSITY PKWY
Second Line :
City : LEESVILLE
State : LA
Zip : 71446-9041
Country : US
Telephone Number : 337-392-3800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2014
Last Update Date : 09/08/2023

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