Provider Demographics
NPI:1093579161
Name:BLACKBURN-LOVE, SUSAN (LMSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BLACKBURN-LOVE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1697 E WILLIAMS FIELD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-6205
Mailing Address - Country:US
Mailing Address - Phone:480-282-8679
Mailing Address - Fax:
Practice Address - Street 1:1697 E WILLIAMS FIELD RD STE 102
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-6205
Practice Address - Country:US
Practice Address - Phone:480-282-8679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-183411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical