# JANICE BLAKE APRN, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003496829
- **Authorized official:** JANICE BLAKE PMHNP-BC (OWNER/OPERATOR)
- **Authorized official phone:** (860) 266-7826

## Contact information

- **Practice address:** 181 THOMPSON ST, S GLASTONBURY, CT 06073-2919
- **Practice address phone:** (860) 266-7826
- **Mailing address:** 181 THOMPSON ST, S GLASTONBURY, CT 06073-2919

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 04/14/2021
- **Last updated:** 06/15/2021