Provider Demographics
NPI:1447256391
Name:BLOCKER, RICHARD ALAN (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:BLOCKER
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 1:79 PARK LN
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:LA
Mailing Address - Zip Code:70437-7721
Mailing Address - Country:US
Mailing Address - Phone:985-718-9110
Mailing Address - Fax:
Practice Address - Street 1:79 PARK LN
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:LA
Practice Address - Zip Code:70437-7721
Practice Address - Country:US
Practice Address - Phone:985-718-9109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA570103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA$$$$$$$$$0OtherBCBS
LAP00068891Medicare PIN
LA5S457CF32Medicare PIN
LAP00319018Medicare PIN
LA5S457D205Medicare PIN