| Irene T Blackford Phd Llc | |
|
1373b W 6th St Erie PA 16505-2503 | |
| (814) 873-4141 | |
| (814) 459-4673 |
| Full Name | Irene T Blackford Phd Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1373b W 6th St, Erie, Pennsylvania |
| Authorized Official Name and Position | Irene Blackford (PSYCHOLOGIST) |
| Authorized Official Contact | 8148734141 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Irene T Blackford Phd Llc 1373b W 6th St Erie PA 16505-2503 Ph: (814) 873-4141 | Irene T Blackford Phd Llc 1373b W 6th St Erie PA 16505-2503 Ph: (814) 873-4141 |
| NPI Number | 1245650845 |
|---|---|
| Provider Enumeration Date | 04/22/2014 |
| Last Update Date | 11/01/2018 |
| Medicare PECOS PAC ID | 0446474910 |
|---|---|
| Medicare Enrollment ID | O20140624002033 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245650845 | NPI | - | NPPES |
| 349983 | Other | PA | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PS006739 (Pennsylvania) | Primary |
| Provider Name | Irene T Blackford |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1619273406 PECOS PAC ID: 9931370277 Enrollment ID: I20110919000424 |
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