Individual
DR. MICHELLE A BLACKMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 920-7971
Mailing address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 920-7971
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
020213
NY
Other
Enumeration date
08/23/2013
Last updated
10/02/2013
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