Individual
PHILLIPA BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
140 DEWITT ST, NEW HAVEN, CT 06519-2133
(203) 691-2791
(203) 503-6515
Mailing address
140 DEWITT ST, NEW HAVEN, CT 06519-2133
(203) 691-2791
(203) 503-6515
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004235900
—
CT
05
—
004235918
—
CT
Enumeration date
10/25/2012
Last updated
10/25/2012
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