Active NPI
Elizabeth Dale Blair, PHD
- Clinical Psychologist
- Media, PA
National Provider Identifier
1033272216
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS0033762
- Practice address
- 280 North Providence Road
Media, PA 19063 - Phone
- (610) 565-1129
- NPI assigned
- Dec 18, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PS0033762 | PA | Primary |
Addresses
Primary practice location
280 North Providence Road
Media, PA 19063
Mailing address
280 North Providence Road
Media, PA 19063
Phone (610) 565-1129
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 280714000 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS0033762 | PA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378598400000",
"number": "1033272216",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "280 NORTH PROVIDENCE ROAD",
"city": "MEDIA",
"state": "PA",
"postal_code": "19063",
"telephone_number": "610-565-1129"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "280 NORTH PROVIDENCE ROAD",
"city": "MEDIA",
"state": "PA",
"postal_code": "19063",
"telephone_number": "610-565-1129"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAIR",
"first_name": "ELIZABETH",
"middle_name": "DALE",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-18",
"last_updated": "2013-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS0033762",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "280714000",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Media, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.