Individual
MR. JONATHAN T BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
126 WILLOW AVE, OLYPHANT, PA 18447-1442
(570) 382-8157
Mailing address
127 CHURCH ST, DUNMORE, PA 18512-1907
(570) 878-5008
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW137924
PA
Other
Enumeration date
09/11/2023
Last updated
09/11/2023
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