Provider Demographics
NPI:1619468204
Name:BLACKMER, RACHEL ILISA (LCSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ILISA
Last Name:BLACKMER
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 1:29 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-5315
Mailing Address - Country:US
Mailing Address - Phone:860-550-3020
Mailing Address - Fax:
Practice Address - Street 1:85 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-2812
Practice Address - Country:US
Practice Address - Phone:860-695-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-20
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT115381041C0700X
MA000225947104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker