Provider Demographics
NPI:1902177884
Name:BLACKMON, KAHNI C (PHD)
Entity Type:Individual
Prefix:
First Name:KAHNI
Middle Name:C
Last Name:BLACKMON
Suffix:
Gender:F
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:MGH REVERE HEALTHCARE CENTER
Mailing Address - Street 2:300 OCEAN AVE.
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151
Mailing Address - Country:US
Mailing Address - Phone:781-485-6180
Mailing Address - Fax:
Practice Address - Street 1:MGH REVERE HEALTHCARE CENTER
Practice Address - Street 2:300 OCEAN AVE.
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151
Practice Address - Country:US
Practice Address - Phone:781-485-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSY-94392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry