Healthcare Provider Details

I. General information

NPI: 1235237009
Provider Name (Legal Business Name): ANNE H BLAKE LMHC, LADC, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 WALNUT ST APT 9
NATICK MA
01760-3564
US

IV. Provider business mailing address

12 WALNUT ST APT 9
NATICK MA
01760-3564
US

V. Phone/Fax

Practice location:
  • Phone: 617-543-3652
  • Fax:
Mailing address:
  • Phone: 617-543-3652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1397
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number05-147
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5096
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: