Provider Demographics
NPI:1144489683
Name:BLACKWELL, KATHRYN V (DO)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:V
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:46 MOHAWK TRL
Mailing Address - Street 2:
Mailing Address - City:MEDFORD LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-1527
Mailing Address - Country:US
Mailing Address - Phone:609-234-0103
Mailing Address - Fax:856-459-8211
Practice Address - Street 1:215 S BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-3479
Practice Address - Country:US
Practice Address - Phone:856-459-8231
Practice Address - Fax:856-459-8211
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB063738002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry