Jeffrey Blake, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LC9874 Issued in ME

Practice address

22 Monument Square
#403
Portland, ME 04101-3914

Phone

(207) 749-9075

NPI assigned

Aug 11, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Maine Behavioral Healthcare

  • Community/Behavioral Health Agency
  • Portland, ME
  • NPI 1962422964
  NPD (past)
• Protea Behavioral Health Services

  • Public Health or Welfare Agency
  • Bangor, ME
  • NPI 1700814712
  NPD (past)
• Sweetser

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Saco, ME
  • NPI 1538122445
  NPD (past)

Specialty

Clinical Social Worker

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362960000000",
    "number": "1003827239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 MONUMENT SQ",
            "address_2": "#403",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041014082",
            "telephone_number": "207-749-9075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 MONUMENT SQUARE",
            "address_2": "#403",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041013914",
            "telephone_number": "207-749-9075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "JEFFREY",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2013-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC9874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "325620099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valerie Blais, MT
• Gregory Blaisdell, MD
• Laura L Blaisdell, MD/MPH
• Oaklin Blaisdell, LCSW
• Hayley Marie Blaise, CRNA
• Lori E B Blake
• Rachael Y Blake, MD
• Victoria Blake
• Paul Blakeslee, MS, RD-AP, LD, CNSC
• Holly Blanchard, LCSW

• All providers in Portland, ME
• Clinical Social Worker in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.