Provider Demographics
NPI:1053360263
Name:PSYCHIATRIC ASSOCIATES OF THE SHENANDOAH
Entity type:Organization
Organization Name:PSYCHIATRIC ASSOCIATES OF THE SHENANDOAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:BLINN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:504-932-7800
Mailing Address - Street 1:920 SHENANDOAH VILLAGE DRIVE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980
Mailing Address - Country:US
Mailing Address - Phone:540-932-7800
Mailing Address - Fax:540-932-7191
Practice Address - Street 1:920 SHENANDOAH VILLAGE DRIVE
Practice Address - Street 2:SUITE 124
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980
Practice Address - Country:US
Practice Address - Phone:540-932-7800
Practice Address - Fax:540-932-7191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YP2500X, 103TC0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty