Provider Demographics
NPI:1750485876
Name:BLANCHARD, DALMER A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DALMER
Middle Name:A
Last Name:BLANCHARD
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:PO BOX 5583
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70469
Mailing Address - Country:US
Mailing Address - Phone:985-649-2808
Mailing Address - Fax:
Practice Address - Street 1:620 OAK HARBOR BLVD
Practice Address - Street 2:STE 101
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8862
Practice Address - Country:US
Practice Address - Phone:985-649-2808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3948104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X399Medicare ID - Type Unspecified