Provider Demographics
NPI:1326136284
Name:BLACKBURN, CLAUDIA A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:A
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 SKYLINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4441
Mailing Address - Country:US
Mailing Address - Phone:717-299-7202
Mailing Address - Fax:717-627-3550
Practice Address - Street 1:524 FRONT STREET
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-1708
Practice Address - Country:US
Practice Address - Phone:717-299-7202
Practice Address - Fax:717-627-3550
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAPS016125103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist