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General NPI Number Information
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NPI Number | 1972760585
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Entity Type | Individual
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Provider Name | JANIE KATHERINE BLAKE SOCIAL WORKER
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Gender | Female
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 4431 DAVIE ROAD AKA 64TH AVENUE SUITE 105
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City | DAVIE
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State | FL
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Zip | 33314-3458
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Country | US
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Telephone | 954-788-2355
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Fax | 954-781-3551
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Provider Business Mailing Address
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Address Line | 2601 NE 15TH STREET
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City | POMPANO BEACH
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State | FL
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Zip | 33062-8253
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Country | US
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Telephone | 954-788-2355
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Fax | 954-781-3551
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | SW599
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW599
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License Number State | FL
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