Provider Demographics
NPI:1053318360
Name:BLACKFORD, RICHARD CHADWICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CHADWICK
Last Name:BLACKFORD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2346
Mailing Address - Country:US
Mailing Address - Phone:814-835-7043
Mailing Address - Fax:814-838-2925
Practice Address - Street 1:1444 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2346
Practice Address - Country:US
Practice Address - Phone:814-835-7043
Practice Address - Fax:814-838-2925
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-006224-L103TC0700X
CAPSY-11983103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001560510Medicaid
PA001560510Medicaid