Provider Demographics
NPI:1336868413
Name:BLACKMAN, LAURIE (LMSW, LGSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:LMSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10769 LESTER ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3760
Mailing Address - Country:US
Mailing Address - Phone:202-641-1129
Mailing Address - Fax:
Practice Address - Street 1:10769 LESTER ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3760
Practice Address - Country:US
Practice Address - Phone:202-641-1129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50080171104100000X
MD16431104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker