Provider Demographics
NPI:1972760585
Name:BLAKE, JANIE KATHERINE (SOCIAL WORKER)
Entity type:Individual
Prefix:MS
First Name:JANIE
Middle Name:KATHERINE
Last Name:BLAKE
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 NE 15TH STREET
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-8253
Mailing Address - Country:US
Mailing Address - Phone:954-788-2355
Mailing Address - Fax:954-781-3551
Practice Address - Street 1:4431 DAVIE ROAD AKA 64TH AVENUE
Practice Address - Street 2:SUITE 105
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3458
Practice Address - Country:US
Practice Address - Phone:954-788-2355
Practice Address - Fax:954-781-3551
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW599101Y00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor