=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538263090
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL G BLYMYER LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2006
-----------------------------------------------------
Last Update Date | 05/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9625 SURVEYOR CT SUITE #210
-----------------------------------------------------
City | MANASSAS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20110-4422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-393-9527
-----------------------------------------------------
Fax | 703-330-3966
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8140 ASHTON AVE SUITE #100
-----------------------------------------------------
City | MANASSAS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20109-5698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-393-9527
-----------------------------------------------------
Fax | 703-330-3966
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904001265
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------