| Entity Name: | MARY BETH R. BLACKWELL LCSW, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 13 Aug 2024 (6 months ago) |
| Document Number: | L24000355456 |
| Address: | 220 ARLINGTON WAY, ORMOND BEACH, FL 32176 |
| Mail Address: | 220 ARLINGTON WAY, ORMOND BEACH, FL 32176 |
| ZIP code: | 32176 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578395950 | 2024-08-15 | 2024-11-06 | 220 ARLINGTON WAY, ORMOND BEACH, FL, 321768164, US | 220 ARLINGTON WAY, ORMOND BEACH, FL, 321768164, US | |||||||||||||
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| Phone | +1 913-709-3209 |
Authorized person
| Name | MARY BETH BLACKWELL |
| Role | OWNER |
| Phone | 9137093209 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BLACKWELL, MARY BETH R | Agent | 2020 ARLINGTON WAY, ORMOND BEACH, FL 32176 |
| Name | Role | Address |
|---|---|---|
| BLACKWELL, MARY BETH R | Manager | 2020 ARLINGTON WAY, ORMOND BEACH, FL 32176 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-09-09 | 220 ARLINGTON WAY, ORMOND BEACH, FL 32176 | No data |
| CHANGE OF MAILING ADDRESS | 2024-09-09 | 220 ARLINGTON WAY, ORMOND BEACH, FL 32176 | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-08-13 |
Date of last update: 07 Feb 2025
Sources: Florida Department of State
