Provider Demographics
NPI:1952734980
Name:BLACKMAN, JIRZIA F (LCSW)
Entity type:Individual
Prefix:
First Name:JIRZIA
Middle Name:F
Last Name:BLACKMAN
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 1:11901 TOEPPERWEIN RD STE 1106
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3159
Mailing Address - Country:US
Mailing Address - Phone:210-286-9339
Mailing Address - Fax:210-951-8962
Practice Address - Street 1:11901 TOEPPERWEIN RD STE 1106
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3159
Practice Address - Country:US
Practice Address - Phone:210-286-9339
Practice Address - Fax:210-951-8962
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080819-11041C0700X
TX646191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX378569302Medicaid