Provider Demographics
NPI:1891882577
Name:BLAKE, ANGELA MONICA (LCSWC)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MONICA
Last Name:BLAKE
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:MONICA
Other - Last Name:ACKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSWC
Mailing Address - Street 1:106 MILFORD ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6953
Mailing Address - Country:US
Mailing Address - Phone:410-742-6016
Mailing Address - Fax:
Practice Address - Street 1:106 MILFORD ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6953
Practice Address - Country:US
Practice Address - Phone:443-783-0624
Practice Address - Fax:443-783-0624
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD131471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD100103635OtherAMERICAN PSYCH SYSTEM
MD600014-351OtherMAGELLAN BEHAVIORAL HEALT
MD609550001Medicaid
MDLM49EAOtherCAREFIRST BCBS GROUP
MD384856OtherMANAGED HEALTH NETWORK
517251OtherUHC MAMSI
724338OtherNCPPO PIN
R968OtherCAREFIRST FEDERAL GROUP
MD742LP416Medicare PIN
MD100103635OtherAMERICAN PSYCH SYSTEM