Provider Demographics
NPI:1265044556
Name:BLANCHARD, MARK PEYTON (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:PEYTON
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WINTHROP ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4930
Mailing Address - Country:US
Mailing Address - Phone:617-299-9913
Mailing Address - Fax:
Practice Address - Street 1:106 WINTHROP ST STE 2
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4930
Practice Address - Country:US
Practice Address - Phone:617-299-9913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSY10000947103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical