Provider Demographics
NPI:1235237009
Name:BLAKE, ANNE H (LMHC, LADC, ATR-BC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:H
Last Name:BLAKE
Suffix:
Gender:F
Credentials:LMHC, LADC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WALNUT ST APT 9
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3564
Mailing Address - Country:US
Mailing Address - Phone:617-543-3652
Mailing Address - Fax:
Practice Address - Street 1:12 WALNUT ST APT 9
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3564
Practice Address - Country:US
Practice Address - Phone:617-543-3652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1397101YA0400X
MA05-147221700000X
MA5096101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM1250OtherBLUE CROSS/BLUE SHIELD ID