NPI 1548822000 · live from the CMS NPI Registry
Janice Blake, PMHNP
Nurse Practitioner, Psych/Mental Health in S Glastonbury, CT. National Provider Identifier 1548822000, active.
NPI record
| NPI | 1548822000 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Psych/Mental Health 363LP0808X |
| Practice location | 181 Thompson St, S Glastonbury, CT 06073 |
| Practice phone | 860-266-7826 |
| Enumerated | July 5, 2019 |
| Last updated | June 15, 2021 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner | 363L00000X | 8329 (CT) |
| Nurse Practitioner, Pediatrics | 363LP0200X | 8329 (CT) |
| Nurse Practitioner, Psych/Mental Health primary | 363LP0808X | 8329 (CT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.