DR. Michael J Blacconiere, PH.D.

NPI #1801977269 in Hines, Illinois

Provider Information

NPI Number: 1801977269
Entity Type: Individual
Name: DR. Michael J Blacconiere, PH.D.
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Psychologist - Clinical
Credential: PH.D.
Enumeration Date: Oct 18, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: HINES VA HOSPITAL
Address 2: 5TH AVE & ROOSEVELT RD
City: Hines
State: Illinois
ZIP Code: 60141
Phone: (708) 202-2656

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - Clinical — Clinical	103TC0700X	Primary

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