Healthcare Provider Details

I. General information

NPI: 1841835444
Provider Name (Legal Business Name): ADAM SCOTT BLACKBURN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 LOCUST ST
NORTHAMPTON MA
01060-2056
US

IV. Provider business mailing address

70 CONZ ST
NORTHAMPTON MA
01060-3830
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-8700
  • Fax:
Mailing address:
  • Phone: 415-235-5627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1775
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: