Doctor Name: | ELIZABETH DALE BLAIR |
NPI Number: | 1033272216 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | PS0033762 |
Business Practice Address: | 280 North Providence Road Media, PA - 19063 |
Business Phone Number: | 6105651129 |
Business Fax Number: | |
Mailing Address: | 280 North Providence Road, MEDIA |
State: | PA |
Postal Code: | 19063 |
Phone Number: | 6105651129 |
Fax Number: | |
NPI Enumeration Date: | 12/18/2006 |
NPI Last Update Date: | 09/08/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PS0033762 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |