Provider Demographics
NPI:1972168326
Name:BLAKE, CYNTHIA J (LCSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:BLAKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:J
Other - Last Name:O'KEEFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:54 HILL ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1637
Mailing Address - Country:US
Mailing Address - Phone:201-554-1998
Mailing Address - Fax:201-554-1996
Practice Address - Street 1:75 N MAPLE AVE STE 201
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3261
Practice Address - Country:US
Practice Address - Phone:201-554-1998
Practice Address - Fax:201-554-1996
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL063179001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical