Individual
TAMARA J BLACKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
10 BALSAM DR, BOOTHBAY, ME 04537-4466
(207) 902-3477
Mailing address
10 BALSAM DR, BOOTHBAY, ME 04537-4466
(207) 902-3477
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC10800
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
267320099
—
ME
Enumeration date
01/14/2007
Last updated
09/06/2012
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