Provider Demographics
NPI:1386310084
Name:MOONEY, BLAKE ALLISON (LMHC)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:ALLISON
Last Name:MOONEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:BLAKE
Other - Middle Name:ALLISON
Other - Last Name:MCHUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:531 E 72ND ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:531 E 72ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4015
Practice Address - Country:US
Practice Address - Phone:484-574-2734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-22
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011506101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health