Organization Name: | KATHERINE BLACKWELL, LCSW - LIFE SERVICES |
NPI Number: | 1194077222 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KATHERINE BLACKWELL (MANAGER) |
Mailing Address: | 2117 Stewart Ln Mount Dora |
State: | FL US |
Postal Code: | 327579507 |
Phone Number: | 3524094077 |
Fax Number: | |
NPI Enumeration Date: | 10/12/2012 |
NPI Last Update Date: | 10/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | SW9581 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |