Provider Demographics
NPI:1457768574
Name:BLACKWOOD, NADINE LORRAINE
Entity Type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:LORRAINE
Last Name:BLACKWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 ROOSEVELT ST
Mailing Address - Street 2:FL. 2
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-3045
Mailing Address - Country:US
Mailing Address - Phone:860-729-5731
Mailing Address - Fax:
Practice Address - Street 1:147 ROOSEVELT ST
Practice Address - Street 2:FL. 2
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-3045
Practice Address - Country:US
Practice Address - Phone:860-729-5731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker