Provider Demographics
NPI:1770886137
Name:BLAKE, CHRISTINE GROVER (BCBA)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:GROVER
Last Name:BLAKE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:EAST SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02537-0725
Mailing Address - Country:US
Mailing Address - Phone:508-932-8526
Mailing Address - Fax:
Practice Address - Street 1:449 ROUTE 6A
Practice Address - Street 2:UNIT 7
Practice Address - City:EAST SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02537
Practice Address - Country:US
Practice Address - Phone:508-932-8526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA943103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst