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General NPI Number Information
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NPI Number | 1619468204
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Entity Type | Individual
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Provider Name | RACHEL ILISA BLACKMER LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/20/2018
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 85 EDWARDS ST
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City | HARTFORD
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State | CT
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Zip | 06120-2812
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Country | US
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Telephone | 860-695-6900
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Fax |
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Provider Business Mailing Address
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Address Line | 29 KENNEDY DR
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City | ENFIELD
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State | CT
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Zip | 06082-5315
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Country | US
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Telephone | 860-550-3020
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11538
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 000225947
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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