| Doctor Name: | NELY BLACKWELL |
| NPI Number: | 1427403930 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LICSW |
| License Number: | 118655 |
| Business Practice Address: | 5342 Dudley Blvd. Mcclellan, CA - 956522513 |
| Business Phone Number: | 9166408080 |
| Business Fax Number: | |
| Mailing Address: | 5342 Dudley Blvd, MCCLELLAN |
| State: | CA |
| Postal Code: | 956522513 |
| Phone Number: | 9166408080 |
| Fax Number: | |
| NPI Enumeration Date: | 05/03/2016 |
| NPI Last Update Date: | 05/03/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 118655 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |