Provider Demographics
NPI:1942186218
Name:BLAKE, ESSENCE (MHC-LP)
Entity type:Individual
Prefix:
First Name:ESSENCE
Middle Name:
Last Name:BLAKE
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 W 25TH ST APT 304
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-7088
Mailing Address - Country:US
Mailing Address - Phone:347-856-7758
Mailing Address - Fax:
Practice Address - Street 1:159 BLEECKER ST APT 2A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1490
Practice Address - Country:US
Practice Address - Phone:917-382-8075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP137650101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health