Provider Demographics
NPI:1851313951
Name:BLAKEMORE, DAVID (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:BLAKEMORE
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 SPRING ST
Mailing Address - Street 2:A3
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4027
Mailing Address - Country:US
Mailing Address - Phone:240-353-0661
Mailing Address - Fax:301-589-9129
Practice Address - Street 1:1107 SPRING ST
Practice Address - Street 2:A3
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4027
Practice Address - Country:US
Practice Address - Phone:240-353-0661
Practice Address - Fax:301-589-9129
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD102911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
K2660001OtherBLUECROSS BLUESHIELD