Provider Demographics
NPI:1659444859
Name:BLAKE, CHRISTOPHER HAMLIN (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:HAMLIN
Last Name:BLAKE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 STANDISH RD
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-5104
Mailing Address - Country:US
Mailing Address - Phone:781-934-2356
Mailing Address - Fax:
Practice Address - Street 1:288 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:WHITMAN
Practice Address - State:MA
Practice Address - Zip Code:02382-1820
Practice Address - Country:US
Practice Address - Phone:781-447-6425
Practice Address - Fax:781-447-1786
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113317101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health