Provider Demographics
NPI:1982637799
Name:BLAKE-GREENBERG, KATHIE
Entity Type:Individual
Prefix:DR
First Name:KATHIE
Middle Name:
Last Name:BLAKE-GREENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 2ND ST N STE 7
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-3503
Mailing Address - Country:US
Mailing Address - Phone:727-725-8820
Mailing Address - Fax:727-725-8361
Practice Address - Street 1:801 2ND ST N STE 7
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3503
Practice Address - Country:US
Practice Address - Phone:727-725-8820
Practice Address - Fax:727-725-8361
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20794103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical