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General NPI Number Information
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NPI Number | 1942376405
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Entity Type | Individual
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Provider Name | CHRISTINE CAMERON BLAKE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 77 S MAIN ST
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City | WATERBURY
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State | VT
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Zip | 05676-1555
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Country | US
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Telephone | 802-793-1774
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Fax | 802-496-2494
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Provider Business Mailing Address
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Address Line | 71 NOYES RD
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City | WATERBURY
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State | VT
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Zip | 05676-8911
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Country | US
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Telephone | 802-223-9150
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 846
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License Number State | VT
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