Provider Demographics
NPI:1023209665
Name:BLACKMAN, LINDA ELLEN (L,CSW-C)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ELLEN
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:L,CSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7112 FAIRFAX RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1235
Mailing Address - Country:US
Mailing Address - Phone:301-530-3505
Mailing Address - Fax:
Practice Address - Street 1:5225 POOKS HILL RD
Practice Address - Street 2:SUITE 4
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2052
Practice Address - Country:US
Practice Address - Phone:301-530-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03623106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist