E. Lawrence Blackwell Jr., LCSW, CAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

004581 Issued in CT

Practice address

140 Glastonbury Blvd
Somerset SQ. 2ND Floor
Glastonbury, CT 06033-4402

Phone

(860) 212-5824

NPI assigned

Jun 10, 2009

Last updated

Jun 10, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1244592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244592000000",
    "number": "1285861716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 REDWOOD RD",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060406329",
            "telephone_number": "860-643-4684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 GLASTONBURY BLVD",
            "address_2": "SOMERSET SQ. 2ND FLOOR",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060334402",
            "telephone_number": "860-212-5824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "E.",
        "middle_name": "LAWRENCE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LCSW, CAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-10",
        "last_updated": "2009-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "004581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• BH Salmon Brook LLC (Civita Care Center at Salmon Brook)
• Bharat Bhushan, ARNP
• Avinash S Bidra, BDS, MS, FACP
• Karen Bidwell, PT
• Rosanne Bisi, LMT
• Edward Andrew Blanchette, M.D.
• Megan Marie Blanchette, AU.D.
• Madeline Blinderman
• Blue Laurel, Inc.
• Steven Harrison Blume, DPM

• Clinical Social Worker in Glastonbury, CT
• Providers in Glastonbury, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2009; 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.