Provider Demographics
NPI:1194583948
Name:BLACHURA, VALERIE PAIGE (MSW)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:PAIGE
Last Name:BLACHURA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 110TH AVE N APT 509
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3153
Mailing Address - Country:US
Mailing Address - Phone:716-698-6390
Mailing Address - Fax:
Practice Address - Street 1:4107 W SPRUCE ST STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-2346
Practice Address - Country:US
Practice Address - Phone:813-636-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW192311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical