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NPI Code Detail

MEDICARE: MR. JACK FRANCIS BLAKE

MEDICARE: MR. JACK FRANCIS BLAKE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1730785726
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JACK FRANCIS BLAKE
Provider Business Mailing Address
First Line : 6225 SMITH AVE STE 1001A
Second Line :
City : BALTIMORE
State : MD
Zip : 21209-3626
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 155 WEST ST STE 7
Second Line :
City : WILMINGTON
State : MA
Zip : 01887-6010
Country : US
Telephone Number : 508-363-0200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2020
Last Update Date : 12/20/2024

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Directions to “ MR. JACK FRANCIS BLAKE ” Practice Location

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