Carolyn W Blackburn, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LC7316 Issued in ME

Practice address

329 Bath Rd
Brunswick, ME 04011-2673

Phone

(207) 373-3070

Fax

(207) 373-3070

NPI assigned

Jul 26, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Carolyn Wood Stephens Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Charlotte White Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Dover Foxcroft, ME
  • NPI 1649337197
  NPD (past)
• Penquis C.a.P., Inc.

  • Community/Behavioral Health Agency
  • Bangor, ME
  • NPI 1720087075
  NPD (past)

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

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313625600000",
    "number": "1669472247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "329 BATH RD",
            "city": "BRUNSWICK",
            "state": "ME",
            "postal_code": "040112673",
            "telephone_number": "207-373-3070",
            "fax_number": "207-373-3070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "329 BATH RD",
            "city": "BRUNSWICK",
            "state": "ME",
            "postal_code": "040112673",
            "telephone_number": "207-373-3070",
            "fax_number": "207-373-3070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "CAROLYN",
        "middle_name": "W",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-26",
        "last_updated": "2011-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC7316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287340099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROLYN",
            "last_name": "STEPHENS",
            "middle_name": "WOOD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Richard Beveridge, M.D.
• Beyond Words Medical Speech Pathology
• Ira A Bird, MD
• Judith Biscaia
• Brian Bisson
• Aleksandra Maria Blackmer, PA-C
• Karmen K Blackstone, A.N.P.
• Laurie A. Blain, LCSW
• Dawn Blake, LCSW
• Brittany Ann Wallingford Blakemore, LMT

• All providers in Brunswick, ME
• Clinical Social Worker in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2011; 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.