Provider Demographics
NPI:1144615600
Name:RICHARD C. BLACKFORD, PH.D. P.C.
Entity Type:Organization
Organization Name:RICHARD C. BLACKFORD, PH.D. P.C.
Other - Org Name:AFFILIATED COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:BLACKFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:814-835-7043
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006224L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053318360OtherPERSONAL NPI
R05365Medicare UPIN