Provider Demographics
NPI:1912640046
Name:BLAKE, LAUREN PERRY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:PERRY
Last Name:BLAKE
Suffix:
Gender:F
Credentials:PSYD
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Other - Credentials:
Mailing Address - Street 1:6401 SANTA MONICA AVE NE APT 3059
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4174
Mailing Address - Country:US
Mailing Address - Phone:602-524-0300
Mailing Address - Fax:
Practice Address - Street 1:10515 W SANTA FE DR
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3020
Practice Address - Country:US
Practice Address - Phone:623-832-6530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-17
Last Update Date:2022-04-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist