Provider Demographics
NPI:1932723525
Name:BLAKE, ERIN LOUISE (LSW)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:LOUISE
Last Name:BLAKE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9021 SKYPARK DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9515
Mailing Address - Country:US
Mailing Address - Phone:330-641-9951
Mailing Address - Fax:
Practice Address - Street 1:104 SPINK ST
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-3652
Practice Address - Country:US
Practice Address - Phone:330-264-8498
Practice Address - Fax:330-264-3777
Is Sole Proprietor?:No
Enumeration Date:2020-05-30
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.19045581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical