| Mary Beth R Blackwell Lcsw Llc | |
|
220 Arlington Way Ormond Beach FL 32176-8164 | |
| (386) 882-7251 | |
| Not Available |
| Full Name | Mary Beth R Blackwell Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 220 Arlington Way, Ormond Beach, Florida |
| Authorized Official Name and Position | Mary Beth Blackwell (OWNER) |
| Authorized Official Contact | 3868827251 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Beth R Blackwell Lcsw Llc 220 Arlington Way Ormond Beach FL 32176-8164 Ph: (386) 882-7251 | Mary Beth R Blackwell Lcsw Llc 220 Arlington Way Ormond Beach FL 32176-8164 Ph: (386) 882-7251 |
| NPI Number | 1578395950 |
|---|---|
| Provider Enumeration Date | 08/15/2024 |
| Last Update Date | 03/03/2025 |
| Certification Date | 03/03/2025 |
| Medicare PECOS PAC ID | 3971043308 |
|---|---|
| Medicare Enrollment ID | O20240911003395 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578395950 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Mary Beth Russo Blackwell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063731263 PECOS PAC ID: 8224359203 Enrollment ID: I20221115000356 |
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