Individual
DR. ROBERT R. BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
8433 HARCOURT RD, SUITE 200, INDIANAPOLIS, IN 46260-2190
(317) 338-4692
(317) 338-4693
Mailing address
7974 N ILLINOIS ST, INDIANAPOLIS, IN 46260-2971
(317) 338-4692
(317) 338-4693
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20040385
IN
103TC0700X
Clinical Psychologist
20040385
IN
103TH0100X
Health Service Psychologist
20040385
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000184454
ANTHEM/ BC PROVIDER #
IN
05
—
100131760A
—
IN
Enumeration date
06/23/2006
Last updated
11/25/2022
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