Provider Demographics
NPI:1467847426
Name:BLAKER, MARGUERITA SITRIN (MA)
Entity Type:Individual
Prefix:MS
First Name:MARGUERITA
Middle Name:SITRIN
Last Name:BLAKER
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 1:2400 CROWNPOINT EXECUTIVE DRIVE
Mailing Address - Street 2:SUITE 100, OFFICE #5
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-6726
Mailing Address - Country:US
Mailing Address - Phone:828-680-0466
Mailing Address - Fax:
Practice Address - Street 1:2400 CROWNPOINT EXECUTIVE DRIVE
Practice Address - Street 2:SUITE 100, OFFICE #5
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227
Practice Address - Country:US
Practice Address - Phone:828-680-0466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2168103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent