Provider Demographics
NPI:1376890566
Name:BLANKENSHIP, BRIE (MA)
Entity Type:Individual
Prefix:
First Name:BRIE
Middle Name:
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 W VIRGINIA LN
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-2327
Mailing Address - Country:US
Mailing Address - Phone:727-386-3852
Mailing Address - Fax:
Practice Address - Street 1:1402 W VIRGINIA LN
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-2327
Practice Address - Country:US
Practice Address - Phone:727-386-3852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health