Provider Demographics
NPI:1114958915
Name:BLAKE, SARAH JUDITH (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JUDITH
Last Name:BLAKE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10630 LITTLE PATUXENT PKWY STE 313
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6216
Mailing Address - Country:US
Mailing Address - Phone:410-988-4002
Mailing Address - Fax:410-988-2024
Practice Address - Street 1:10630 LITTLE PATUXENT PKWY STE 313
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-6216
Practice Address - Country:US
Practice Address - Phone:410-988-4002
Practice Address - Fax:410-988-2024
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID425551041C0700X
MD126821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
M468Medicare ID - Type Unspecified