Individual
NATICA BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
170 BENNETT ST, BRIDGEPORT, CT 06605
(203) 330-6790
Mailing address
170 BENNETT ST, BRIDGEPORT, CT 06605-2901
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/05/2018
Last updated
11/06/2019
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