Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | MA | |
Y | 103T00000X | Psychologist | MA |
NPI | 1003098575 |
---|---|
Provider Name | Dr. Abigail B Blackburn |
First Address | Newton, MA 02459-2244 |
Second Address | Newton, MA 02459-2244 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2007 |
Last Update Date | 27/11/2007 |