Provider Demographics
NPI:1558954164
Name:BLAKE, RACHEL ERIN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ERIN
Last Name:BLAKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:ERIN
Other - Last Name:AGUIAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:300 SEASIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 SEASIDE AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4603
Practice Address - Country:US
Practice Address - Phone:475-227-7636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical