Provider Demographics
NPI:1457300667
Name:BLINN, ROBERT H (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:BLINN
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 1:920 SHENANDOAH VILLAGE DR STE 124
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980
Mailing Address - Country:US
Mailing Address - Phone:540-932-7800
Mailing Address - Fax:540-932-7191
Practice Address - Street 1:920 SHENANDOAH VILLAGE DR STE 124
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980
Practice Address - Country:US
Practice Address - Phone:540-932-7800
Practice Address - Fax:540-932-7191
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2179643OtherFIRST HEALTH
083086OtherSENTARA MENTAL HEALTH
173898OtherCOMPSYCH
7700261OtherVIRGINIA PREMIER
061341OtherANTHEM BLUE CROSS
140695OtherVALUE OPTIONS
VA7700261Medicaid
132963OtherMHN
7700261OtherVIRGINIA PREMIER