{
"Npi": {
"NPI": "1487229415",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BLAKE",
"FirstName": "ANDREA",
"MiddleName": "S",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "BLOODBORNE PATHOLOGI",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BLAKE",
"OtherFirstName": "ANDREA",
"OtherMiddleName": "S",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "ANDREA S BLAKE CHC",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "6054 WILMINGTON AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EGG HARBOR TOWNSHIP",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08234-6210",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "609-264-3643",
"MailingAddressFaxNumber": "609-264-3643",
"FirstLinePracticeLocationAddress": "6054 WILMINGTON AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EGG HARBOR TOWNSHIP",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "08234-6210",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "609-761-8762",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/21/2021",
"LastUpdateDate": "11/07/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "171400000X",
"TaxonomyName": "Health & Wellness Coach",
"LicenseNumber": null,
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "171400000X",
"TaxonomyName": "Health & Wellness Coach",
"LicenseNumber": ".",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "101Y00000X",
"TaxonomyName": "Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "174H00000X",
"TaxonomyName": "Health Educator",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}