Healthcare Provider Details

I. General information

NPI: 1053599811
Provider Name (Legal Business Name): KIMBERLY BLAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 06/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 OHARA ST
PITTSBURGH PA
15213-2561
US

IV. Provider business mailing address

200 LOTHROP ST FORBES TOWER SUITE 9055
PITTSBURGH PA
15213-2536
US

V. Phone/Fax

Practice location:
  • Phone: 412-624-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS016133
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: