Provider Demographics
NPI:1073402590
Name:CLOUD, BLAINE (PHD)
Entity type:Individual
Prefix:DR
First Name:BLAINE
Middle Name:
Last Name:CLOUD
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 1:1413 AUTUMN RD
Mailing Address - Street 2:
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2310
Mailing Address - Country:US
Mailing Address - Phone:267-625-7480
Mailing Address - Fax:
Practice Address - Street 1:1413 AUTUMN RD
Practice Address - Street 2:
Practice Address - City:RYDAL
Practice Address - State:PA
Practice Address - Zip Code:19046-2310
Practice Address - Country:US
Practice Address - Phone:267-625-7480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008640L103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist