Provider Demographics
NPI:1083705172
Name:BLANKENSHIP, ELIZABETH JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JEAN
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:
Other - Last Name:BLANKENSHIP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7415 FAIRFAX DRIVE
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668
Mailing Address - Country:US
Mailing Address - Phone:727-847-0243
Mailing Address - Fax:
Practice Address - Street 1:1232 N PINELLAS AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689
Practice Address - Country:US
Practice Address - Phone:727-944-5171
Practice Address - Fax:727-944-5174
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7512104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
K4526OtherGROUP PROVIDER # MCARE B
K4526OtherGROUP PROVIDER # MCARE B