Provider Demographics
NPI:1750403127
Name:BLACKMAN, LORI DAWN (LCSW)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:DAWN
Last Name:BLACKMAN
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 1:406 PARKER IVEY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6513
Mailing Address - Country:US
Mailing Address - Phone:561-602-4114
Mailing Address - Fax:561-455-9988
Practice Address - Street 1:6801 LAKE WORTH RD STE 202
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467
Practice Address - Country:US
Practice Address - Phone:561-249-7335
Practice Address - Fax:561-455-9988
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC.138981041C0700X
CALCS 247221041C0700X
FLSW 73301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001313100Medicaid