Elizabeth Marie Blair, PSYD
Individual provider Active NPI Psychologist · Glendale, WI
NPI 1730107228 · NPPES record last updated Nov 3, 2016
Key facts
- NPI
- 1730107228
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 2121057 (WI)
- Practice address
- 5900 N Port Washington Rd
Ste 230
Glendale, WI 53217 - Phone
- (414) 962-4048
- Fax
- (414) 962-4052
- NPI assigned
- Jul 17, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Psychiatric Consultants and Therapists SC
Practice addresses (Care Compare)
229 E Wisconsin Ave
Suite 600
Milwaukee, WI 53202-4212
Phone (414) 224-3737
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050309000417 | WI | Practitioner - Clinical Psychologist | 4981658218 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2121057 | WI | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psychiatric Consultants & Therapists, SC | Psychologist | Current |
Accepting new patients |
| Health Psychology Associates, S.C. | Psychologist | Past |
Accepting new patients |
Locations
229 E Wisconsin Ave
Ste 60
Milwaukee, WI 53202
Phone (414) 224-3737
229 E Wisconsin Ave
Ste 600
Milwaukee, WI 53202
Phone (414) 224-3737
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2121057 | WI | Yes |
Addresses
Primary practice location
5900 N Port Washington Rd
Ste 230
Glendale, WI 53217
Mailing address
5900 N Port Washington Rd
Ste 230
Glendale, WI 53217
Phone (414) 962-4048
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39125400 | Medicaid | WI |
Other providers in Glendale, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.