Provider Demographics
NPI:1740764844
Name:BLACKBURN, SEAN M (LCSW)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:M
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 DARBY CREEK RD APT D
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1290
Mailing Address - Country:US
Mailing Address - Phone:859-619-7475
Mailing Address - Fax:931-901-1239
Practice Address - Street 1:120 KENTUCKY AVE STE 110
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1978
Practice Address - Country:US
Practice Address - Phone:502-409-6993
Practice Address - Fax:502-409-6775
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical