Thomas Blackwell Jr., L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

007599 Issued in CT

Practice address

80 Virginia Ave
Bridgeport, CT 06610-1506

Phone

(203) 814-2176

NPI assigned

May 7, 2011

Sex

Male

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• State of Connecticut

  • Psychiatric Hospital
  • Bridgeport, CT
  • NPI 1720013360

  CT

  Medicare reassignment NPD
• Thomas Blackwell, LCSW, LLC

  • Clinical Social Worker
  • Stratford, CT
  • NPI 1699319152

  Clinical

  NPD (past) Authorized official
• State of Connecticut

  • Skilled Nursing Facility
  • Rocky Hill, CT
  • NPI 1205951662
  NPD

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 7, 2011.

{
    "created_epoch": "1304726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304726400000",
    "number": "1326330424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 VIRGINIA AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066101506",
            "telephone_number": "203-814-2176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 VIRGINIA AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066101506",
            "telephone_number": "203-814-2176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "THOMAS",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-05-07",
        "last_updated": "2011-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "007599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Birn, PA
• Paige Birney, P.A.
• Jason Bisaillon, MD
• Amber Bjerke, PTA
• Black Rock Physical Therapy
• Christina M Bladek, CRNA
• Thomas Bladek, MD
• Angela Blair Boykin, LPN
• Jonathan Blais, PHARM.D.
• Annemarie Blake

• All providers in Bridgeport, CT
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.