Provider Demographics
NPI:1912336363
Name:BLANDFORD, MERRITT (LCSW)
Entity Type:Individual
Prefix:
First Name:MERRITT
Middle Name:
Last Name:BLANDFORD
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 1:5237 SUMMERLIN COMMONS BLVD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2158
Mailing Address - Country:US
Mailing Address - Phone:239-443-0215
Mailing Address - Fax:
Practice Address - Street 1:5237 SUMMERLIN COMMONS BLVD
Practice Address - Street 2:SUITE 119
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2158
Practice Address - Country:US
Practice Address - Phone:239-443-0215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW105591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical