MEDICARE: KIMBERLY LEE BLACKSHEAR MSW, 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
1	1041C0700X	Clinical Social Worker	C016725	NC
2	1041C0700X	Clinical Social Worker	098453	NY

General Provider Information

NPI Number	:	1366397648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY LEE BLACKSHEAR MSW, LCSW

Provider Business Mailing Address
First Line	:	64 CRESTVIEW DR
Second Line	:
City	:	PITTSFORD
State	:	NY
Zip	:	14534-2241
Country	:	US
Telephone Number	:	919-816-5263
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 CRESTVIEW DR
Second Line	:
City	:	PITTSFORD
State	:	NY
Zip	:	14534-2241
Country	:	US
Telephone Number	:	919-816-5263
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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