Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MH9842 | FL |
NPI | 1003032673 |
---|---|
Provider Name | Cheryl Blackman |
First Address | Royal Palm Beach, FL 33411-1575 |
Second Address | Royal Palm Beach, FL 33411-1575 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 20/05/2009 |