Provider Demographics
NPI:1215691662
Name:BLACKMUN, CORINNE DANIELLE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:DANIELLE
Last Name:BLACKMUN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 569
Mailing Address - Street 2:
Mailing Address - City:HONEY BROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19344-0569
Mailing Address - Country:US
Mailing Address - Phone:484-354-5647
Mailing Address - Fax:
Practice Address - Street 1:2819 WILLOW STREET PIKE
Practice Address - Street 2:SUITE N
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584
Practice Address - Country:US
Practice Address - Phone:717-464-1450
Practice Address - Fax:717-464-0890
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129145104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker