Provider Demographics
NPI:1730197872
Name:BLACKBURN-NOBLE, PAMELA K (LCSW)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:K
Last Name:BLACKBURN-NOBLE
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:PO BOX 918
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40340-0918
Mailing Address - Country:US
Mailing Address - Phone:859-967-8172
Mailing Address - Fax:859-885-5327
Practice Address - Street 1:1000 E LEXINGTON AVE
Practice Address - Street 2:STE. 27
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-9042
Practice Address - Country:US
Practice Address - Phone:859-967-8172
Practice Address - Fax:859-885-5327
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KY0331535Medicare ID - Type UnspecifiedMEDICARE
KYP00238377Medicare ID - Type UnspecifiedRR MEDICARE