Healthcare Provider Details

I. General information

NPI: 1336374826
Provider Name (Legal Business Name): ROBYN BLAKE-MANNING PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 YORK RD STE 800
LUTHERVILLE MD
21093-6011
US

IV. Provider business mailing address

1301 YORK RD STE 800-1106
LUTHERVILLE MD
21093-6035
US

V. Phone/Fax

Practice location:
  • Phone: 443-850-2603
  • Fax:
Mailing address:
  • Phone: 443-579-5557
  • Fax: 443-327-4747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR166864
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: