Provider Demographics
NPI:1427266683
Name:BLAKE, DANIEL ALLYN (MSW)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ALLYN
Last Name:BLAKE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 W 9TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3236
Mailing Address - Country:US
Mailing Address - Phone:907-276-7374
Mailing Address - Fax:907-276-8316
Practice Address - Street 1:1345 W 9TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3236
Practice Address - Country:US
Practice Address - Phone:907-276-7374
Practice Address - Fax:907-276-8316
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical