Blake, Elizabeth

Blake, Elizabeth is an individual health care provider with primary practice located at 14 Fordham Rd , Allston MA 02134-3006. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Blake, Elizabeth can be contacted via phone (617) 782-6460.

Contact Information

Primary practice address
14 Fordham Rd Allston MA 02134-3006
Phone: (617) 782-6460
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X

Profile Details

NPI number 1114109006
LBN Legal business name Blake, Elizabeth
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 3rd, 2007
Last updated Dec 3rd, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114109006 NPPES
Massachusetts Other 1001550 NHP
Massachusetts Other 8411 NHP
Massachusetts MEDICAID 131974 NHP

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