Provider Demographics
NPI:1629278387
Name:BLAINE, CHRISTINE L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:L
Last Name:BLAINE
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:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:PA
Mailing Address - Zip Code:19373-0203
Mailing Address - Country:US
Mailing Address - Phone:610-521-4950
Mailing Address - Fax:610-595-9950
Practice Address - Street 1:405 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-1523
Practice Address - Country:US
Practice Address - Phone:610-521-4950
Practice Address - Fax:610-595-9950
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005745-L103G00000X, 103TB0200X, 103TC0700X, 103TC2200X
DEB1-0000489103G00000X, 103TB0200X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent