MEDICARE: MS. JANET LYNN 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
1	1041C0700X	Clinical Social Worker	SW3599	FL

General Provider Information

NPI Number	:	1851447551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANET LYNN BLACKBURN LCSW

Provider Business Mailing Address
First Line	:	1205 E 8TH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-3503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 N STATE ROAD 7
Second Line	:	BLDG A, SUITE 206
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-5800
Country	:	US
Telephone Number	:	954-735-5068
Fax Number	:	954-735-0314

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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