Provider Demographics
NPI:1639936230
Name:BLAKE, BRITTANY (LMHC)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:BLAKE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 MANTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-1544
Mailing Address - Country:US
Mailing Address - Phone:919-614-8228
Mailing Address - Fax:
Practice Address - Street 1:169 MANTHORNE RD
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1544
Practice Address - Country:US
Practice Address - Phone:919-614-8228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10000470101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health