1891882577 NPI number — MS. ANGELA MONICA BLAKE LCSWC

Table of content: MS. ANGELA MONICA BLAKE LCSWC (NPI 1891882577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891882577 NPI number — MS. ANGELA MONICA BLAKE LCSWC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLAKE
Provider First Name:
ANGELA
Provider Middle Name:
MONICA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ACKERSON
Provider Other First Name:
ANGELA
Provider Other Middle Name:
MONICA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSWC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891882577
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 MILFORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804-6953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-742-6016
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 MILFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21804-6953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-783-0624
Provider Business Practice Location Address Fax Number:
443-783-0624
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  13147 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100103635 . This is a "AMERICAN PSYCH SYSTEM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 600014-351 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 609550001 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: LM49EA . This is a "CAREFIRST BCBS GROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 384856 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 517251 . This is a "UHC MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 724338 . This is a "NCPPO PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: R968 . This is a "CAREFIRST FEDERAL GROUP" identifier . This identifiers is of the category "OTHER".




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