Provider Information for 1639722176
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NAOMI BLAKE LMHC
Sex: Female
NPI: 1639722176
Last Updated: 2019-10-24
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1639722176 | ||||||||||||
| Enumeration Date | 2019-07-23 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 343 NW STRATFORD LN PORT ST LUCIE, FL 34983-3431 United States Phone: 901-335-6091 | Fax: | ||||||||||||
| Primary Practice Address | 1700 SE HILLMOOR DR PORT ST LUCIE, FL 34952-7539 United States Phone: 772-335-9600 | Fax: | ||||||||||||
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