Provider Demographics
NPI:1740887645
Name:BLACKWELL, PAMELA BRIANN (PSYCH ASSOCIATE,LMSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:BRIANN
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:PSYCH ASSOCIATE,LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7902 HUBBLE DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2495
Mailing Address - Country:US
Mailing Address - Phone:404-390-7735
Mailing Address - Fax:
Practice Address - Street 1:5914 HUBBARD DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4823
Practice Address - Country:US
Practice Address - Phone:404-390-7735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-04
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25907104100000X
MDA0541103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker