Provider Demographics
NPI:1225290562
Name:BLESSINGTON, MARY JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JEAN
Last Name:BLESSINGTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N SWAN RD
Mailing Address - Street 2:#111
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1262
Mailing Address - Country:US
Mailing Address - Phone:520-792-3600
Mailing Address - Fax:
Practice Address - Street 1:6701 N CALLE ZELLA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-1103
Practice Address - Country:US
Practice Address - Phone:520-792-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-03911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ26-2861142OtherTAX ID NUMBER