Susan Henry Blackburn, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1719 Issued in FL

Practice address

40 Sarasota Center Blvd Ste 101
Sarasota, FL 34240-8758

Phone

(941) 376-3472

NPI assigned

Aug 5, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684454400000",
    "number": "1073522553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7550 SHADOW GLEN LN",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342412303",
            "telephone_number": "941-376-3472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 SARASOTA CENTER BLVD STE 101",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342408758",
            "telephone_number": "941-376-3472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "SUSAN",
        "middle_name": "HENRY",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-05",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "FL",
            "license": "SW1719",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "1719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robin M. Bixler, DO
• Bizzoom, Inc.
• Bja Incorporated
• BL Horvat MD & Associates, Inc
• Cynthia R Black, AP
• Christine M. Blackmon, M.S.
• Blackstone Health, LLC
• Michael Andrew Blair, D.O.
• Maureen Ann Blais-Gestrich, P.A.-C.
• Derek J Blake, MS

• Clinical Social Worker in Sarasota, FL
• Providers in Sarasota, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.