Provider Demographics
NPI:1265661565
Name:BLAKE, SHERRI LYNN
Entity type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:LYNN
Last Name:BLAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SHERRI
Other - Middle Name:LYN
Other - Last Name:PERUSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:131 MARKET ST.
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901
Mailing Address - Country:US
Mailing Address - Phone:814-535-2277
Mailing Address - Fax:814-534-0935
Practice Address - Street 1:131 MARKET STREET
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901
Practice Address - Country:US
Practice Address - Phone:814-535-2277
Practice Address - Fax:814-534-0935
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health