Individual
MS. ROBERTA LYNN BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED
Contact information
Practice address
950 CAMPBELL AVE, WEST HAVEN, CT 06516-2770
(203) 932-5711
(203) 937-4791
Mailing address
16 WATROUS AVE, BRANFORD, CT 06405-3331
(203) 481-5471
Taxonomy
Speciality
Code
Description
License number
State
225A00000X
Music Therapist
Primary
—
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
225A00000X
MUSIC THERAPIST
CT
Enumeration date
09/20/2006
Last updated
07/08/2007
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