Healthcare Provider Details

I. General information

NPI: 1346724986
Provider Name (Legal Business Name): STEVEN ROBERT BLAKE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7515 CLAREMONT AVE
BERKELEY CA
94705-1432
US

IV. Provider business mailing address

7515 CLAREMONT AVE
BERKELEY CA
94705-1432
US

V. Phone/Fax

Practice location:
  • Phone: 510-520-5944
  • Fax:
Mailing address:
  • Phone: 510-520-5944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS16655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: