Active NPI
Elizabeth Blackburn-Gruver, LCSW
- Clinical Social Worker
- Willingboro, NJ
National Provider Identifier
1063884161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 44SC05190300
- Practice address
- 102 Toledo LN
Willingboro, NJ 08046-3723 - Phone
- (609) 937-0920
- NPI assigned
- Oct 28, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 44SC05190300 | NJ | Primary |
Addresses
Primary practice location
102 Toledo LN
Willingboro, NJ 08046-3723
Mailing address
102 Toledo LN
Willingboro, NJ 08046-3723
Phone (609) 937-0920
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2024 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445990400000",
"number": "1063884161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 TOLEDO LN",
"city": "WILLINGBORO",
"state": "NJ",
"postal_code": "080463723",
"telephone_number": "609-937-0920"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 TOLEDO LN",
"city": "WILLINGBORO",
"state": "NJ",
"postal_code": "080463723",
"telephone_number": "609-937-0920"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKBURN-GRUVER",
"first_name": "ELIZABETH",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-10-28",
"last_updated": "2015-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NJ",
"license": "44SC05190300",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Willingboro, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.