Individual
AMANDA REBECCA BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
29149 CHAPEL PARK DR, WESLEY CHAPEL, FL 33543-4423
(813) 575-8199
Mailing address
6837 40TH LN N, PINELLAS PARK, FL 33781-6178
(727) 741-5684
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW20922
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144988080
NPI
FL
Enumeration date
06/20/2022
Last updated
04/26/2024
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