Katherine Yu Blackwell, LCSW
Individual provider Active NPI Clinical Social Worker · Mount Dora, FL
NPI 1295964948 · NPPES record last updated Oct 11, 2012
Key facts
- NPI
- 1295964948
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- SW9581 (FL)
- Practice address
- 2117 Stewart LN
Mount Dora, FL 32757-9507 - Phone
- (352) 409-4077
- NPI assigned
- Jul 2, 2009
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW9581 | FL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Katherine Blackwell, LCSW - Life Services | Clinical | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SW9581 | FL | Yes |
Addresses
Primary practice location
2117 Stewart LN
Mount Dora, FL 32757-9507
Mailing address
2117 Stewart LN
Mount Dora, FL 32757-9507
Phone (352) 409-4077
Other providers in Mount Dora, FL
- Nicholas Bianco
- Bilingual Behavior Services
- Ajay Harendra Bisht
- Janet L Black
- Sydni Black
- Emerald Monique Blount
- Natasha Shuntay Boges
- Elizabeth Bolano
- Sylvia Boloczko
- Kenneth J Bommarito
All providers in Mount Dora, FL · Clinical Social Worker in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.