Individual
DR. ELIZABETH WINTON BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
915 MIDDLE RIVER DR, SUITE 204, FORT LAUDERDALE, FL 33304-3559
(954) 763-6557
(954) 561-8331
Mailing address
915 MIDDLE RIVER DR, SUITE 204, FORT LAUDERDALE, FL 33304-3559
(954) 763-6557
(954) 561-8331
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY4139
FL
163W00000X
Registered Nurse
RN764412
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
084337
MANAGED HEALTH NETWORK
FL
01
—
098581
VALUE OPTIONS
FL
01
—
299483
AVMED HEALTH PLANS
FL
01
—
4278424
AETNA
FL
01
—
6110620
UNITED BEHAVIORAL HEALTH
FL
01
—
73460
BLUE CROSS BLUE SHIELD
FL
01
—
BLAKELIZ
CORPHEALTH
FL
01
—
IPO41451
MAGELLAN BEHAVIORAL HEALT
FL
Enumeration date
12/06/2006
Last updated
11/18/2010
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