Healthcare Provider Details

I. General information

NPI: 1740887645
Provider Name (Legal Business Name): PAMELA BRIANN BLACKWELL PSYCH ASSOCIATE,LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2020
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5914 HUBBARD DR
ROCKVILLE MD
20852-4823
US

IV. Provider business mailing address

7902 HUBBLE DR
LANHAM MD
20706-2495
US

V. Phone/Fax

Practice location:
  • Phone: 404-390-7735
  • Fax:
Mailing address:
  • Phone: 404-390-7735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberA0541
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number25907
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: