Provider Demographics
NPI:1215086137
Name:BLACKWOOD, HAROLD DANIEL (PHD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:DANIEL
Last Name:BLACKWOOD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6232 N 7TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1839
Mailing Address - Country:US
Mailing Address - Phone:602-230-8324
Mailing Address - Fax:602-274-7402
Practice Address - Street 1:6232 N 7TH ST
Practice Address - Street 2:STE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1839
Practice Address - Country:US
Practice Address - Phone:602-230-8324
Practice Address - Fax:602-274-7402
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ689103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ27056Medicare UPIN
AZZ27057Medicare UPIN