Individual
DR. MICHAEL BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
25 MAIN ST., OFFICE 322, STOCKBRIDGE, MA 01262-0962
(413) 931-5235
Mailing address
PO BOX 962, STOCKBRIDGE, MA 01262-0962
(413) 931-5235
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
10144
MA
Other
Enumeration date
07/17/2015
Last updated
07/17/2015
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