| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 1444 W 38th St, Erie, Pennsylvania |
| Authorized Official Name and Position | Richard C. Blackford (PSYCHOLOGIST) |
| Authorized Official Contact | 8148357043 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1444 W 38th St Erie PA 16508-2346 Ph: (814) 835-7043 | 1444 W 38th St Erie PA 16508-2346 Ph: (814) 835-7043 |
| NPI Number | 1144615600 |
|---|---|
| Provider Enumeration Date | 04/01/2015 |
| Last Update Date | 10/05/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144615600 | NPI | - | NPPES |
| 1053318360 | Other | PERSONAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PS006224L (Pennsylvania) | Primary |
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