Provider Demographics
NPI:1053494773
Name:BLOTCKY, ALAN D (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:D
Last Name:BLOTCKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:ALAN
Other - Middle Name:DAVID
Other - Last Name:BLOTCKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:529 BEACON PKWY W STE 107
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3126
Mailing Address - Country:US
Mailing Address - Phone:205-912-7171
Mailing Address - Fax:205-912-7179
Practice Address - Street 1:529 BEACON PKWY W STE 107
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-3126
Practice Address - Country:US
Practice Address - Phone:205-912-7171
Practice Address - Fax:205-912-7179
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL430103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51079258Medicare ID - Type Unspecified
ALR62407Medicare UPIN