Provider Demographics
NPI:1336299171
Name:BLACKMAN-BUCKWALTER, ELLEN C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:C
Last Name:BLACKMAN-BUCKWALTER
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 1:1100 POWELL ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-3820
Mailing Address - Country:US
Mailing Address - Phone:610-277-4600
Mailing Address - Fax:610-277-4651
Practice Address - Street 1:1217 DEKALB ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3415
Practice Address - Country:US
Practice Address - Phone:610-270-0625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015324103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA068095GNYMedicare ID - Type Unspecified
P83946Medicare UPIN