Provider Demographics
NPI:1174672448
Name:BLACKMER, DANA ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:ROBERT
Last Name:BLACKMER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 GAYTON RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-4963
Mailing Address - Country:US
Mailing Address - Phone:804-741-4500
Mailing Address - Fax:804-741-9188
Practice Address - Street 1:9601 GAYTON RD
Practice Address - Street 2:SUITE 206
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-4963
Practice Address - Country:US
Practice Address - Phone:804-741-4500
Practice Address - Fax:804-741-9188
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001591103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA03818400OtherMAGELLAN
VA056527OtherANTHEM