Individual
GREGORY GEORGE BLAKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1 LONG WHARF DR STE 321, NEW HAVEN, CT 06511-5946
(203) 781-4600
(203) 781-4624
Mailing address
1 LONG WHARF DR STE 321, NEW HAVEN, CT 06511-5946
(203) 781-4600
(203) 781-4624
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10865
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004041000
—
CT
05
—
008003745
—
CT
05
—
008092064
—
CT
Enumeration date
11/21/2019
Last updated
01/24/2022
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