Provider Demographics
NPI:1275592875
Name:BLACKWELL, SCOTT L (PHD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:BLACKWELL
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 1:9426 INDIAN SCHOOL RD NE
Mailing Address - Street 2:SUITE 2 SCOTT BLACKWELL PHD
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112
Mailing Address - Country:US
Mailing Address - Phone:505-342-0400
Mailing Address - Fax:505-342-0500
Practice Address - Street 1:9426 INIDIAN SCHOOL RD NE
Practice Address - Street 2:SUITE 2 SCOTT BLACKWELL PHD
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112
Practice Address - Country:US
Practice Address - Phone:505-342-0400
Practice Address - Fax:505-342-0500
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM295103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist