Thomas Blackwell, LCSW, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

THOMAS BLACKWELL, LCSW, LLC

Practice address

2945 Main St Ste a
Stratford, CT 06614-4978

Phone

(203) 814-2176

NPI assigned

Oct 28, 2019

Organization subpart

No

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

Authorized official

Name

Thomas Blackwell, LCSWNPI 1326330424

Title

Owner

Phone

(203) 814-2176

Specialties & licenses 1

Addresses

Other names 2

• Blackwell Counseling Doing business as
• Thomas Blackwell, LCSW, LLC Former legal business name

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Thomas Blackwell Jr., L.C.S.W.

  • Clinical Social Worker
  • Bridgeport, CT
  • NPI 1326330424

  Clinical

  NPD (past) Authorized official

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

{
    "created_epoch": "1572220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595376000000",
    "number": "1699319152",
    "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",
            "fax_number": "203-330-1237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2945 MAIN ST STE A",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066144978",
            "telephone_number": "203-814-2176"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Church St Ste 602",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "065103014",
            "country_code": "US",
            "telephone_number": "203-814-2176",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THOMAS BLACKWELL, LCSW, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-28",
        "last_updated": "2020-07-22",
        "certification_date": "2020-07-22",
        "status": "A",
        "authorized_official_last_name": "BLACKWELL",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-814-2176",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Tommy@BlackwellCounseling.org",
            "affiliation": "N",
            "endpointDescription": "Business Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2945 Main St Ste A",
            "city": "Stratford",
            "state": "CT",
            "country_code": "US",
            "postal_code": "066144978",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Blackwell Counseling",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Thomas Blackwell, LCSW, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2020; 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.