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NPI Code Detail

MEDICARE: M LESLIE BLOUNT L.C.S.W.

MEDICARE: M LESLIE BLOUNT L.C.S.W.
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
1104100000XSocial WorkerSW 4044FL

General Provider Information

NPI Number : 1326115015
Entity Type Code : Individual
Provider Name (Legal Business Name) : M LESLIE BLOUNT L.C.S.W.
Provider Business Mailing Address
First Line : 7209 HAMMET RD
Second Line :
City : TAMPA
State : FL
Zip : 33647-1206
Country : US
Telephone Number : 813-980-3488
Fax Number : 813-980-3647
Provider Business Practice Location Address
First Line : 14505 BRUCE B DOWNS BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33613-2789
Country : US
Telephone Number : 813-416-1454
Fax Number : 813-978-9744
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2006
Last Update Date : 03/11/2019

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