Provider Demographics
NPI:1023168242
Name:BLAU, WILLIAM H (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
Last Name:BLAU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:87079 AMBOY ROAD
Mailing Address - Street 2:
Mailing Address - City:29 PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277
Mailing Address - Country:US
Mailing Address - Phone:760-367-2117
Mailing Address - Fax:760-367-2117
Practice Address - Street 1:6528A HILLSIDE AVENUE
Practice Address - Street 2:
Practice Address - City:29 PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277
Practice Address - Country:US
Practice Address - Phone:760-367-2117
Practice Address - Fax:760-367-2117
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3657103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY036570Medicaid
CAPSY036570Medicaid