Provider Demographics
NPI:1427353051
Name:BLACKBURN, CARMA J (LCSW)
Entity type:Individual
Prefix:
First Name:CARMA
Middle Name:J
Last Name:BLACKBURN
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 1:16465 E ASHBROOK DR
Mailing Address - Street 2:UNIT B
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-2008
Mailing Address - Country:US
Mailing Address - Phone:480-837-2703
Mailing Address - Fax:
Practice Address - Street 1:16712 E AVENUE OF THE FOUNTAINS
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3816
Practice Address - Country:US
Practice Address - Phone:480-837-2703
Practice Address - Fax:480-837-2703
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-131291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical