Provider Demographics
NPI:1609188473
Name:BLAKESLEE, KIM A (MED)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:A
Last Name:BLAKESLEE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:CHARLEMONT
Mailing Address - State:MA
Mailing Address - Zip Code:01339-0556
Mailing Address - Country:US
Mailing Address - Phone:413-774-1000
Mailing Address - Fax:
Practice Address - Street 1:1 ARCH PL
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2457
Practice Address - Country:US
Practice Address - Phone:413-774-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker