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General NPI Number Information
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NPI Number | 1518857424
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Entity Type | Organization
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Legal Business Name | BLACKBIRD CLINICAL SERVICES
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 100 CENTURY PKWY STE 250
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City | MOUNT LAUREL
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State | NJ
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Zip | 08054-1149
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Country | US
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Telephone | 215-278-9248
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Fax | 610-770-1805
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Provider Business Mailing Address
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Address Line | PO BOX 360957
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City | PITTSBURGH
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State | PA
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Zip | 15251-6957
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Country | US
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Telephone | 484-202-0751
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | NICOLE GARBER
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Credential | MD
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Telephone | 623-980-9997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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