Nikole Evans Blake, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CW024587 Issued in PA

Practice address

1891 Santa Barbara Dr Ste 102
Lancaster, PA 17601-4106

Phone

(717) 936-9758

NPI assigned

Nov 5, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Krem Capital, Inc

  • Professional Counselor
  • Lancaster, PA
  • NPI 1700586674
  NPD

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

{
    "created_epoch": "1509840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1114439734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "763 DEAVER RD",
            "city": "QUARRYVILLE",
            "state": "PA",
            "postal_code": "175669259",
            "telephone_number": "717-799-3180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1891 SANTA BARBARA DR STE 102",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176014106",
            "telephone_number": "717-936-9758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "NIKOLE",
        "middle_name": "EVANS",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-05",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW024587",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "PA",
            "license": "SW134782",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Eleanor Blackburn, AU.D.
• Jennifer Lynn Blackburn
• Karen Dorothy Blackburn, M.S. CCC-SLP
• Christopher Alan Blair, MAMFT
• Michelle Profili Blake, MS, LPC
• Ryleigh Blakley
• Andrew Bland, PHD
• Kirstie R Blank, COTA/L
• Laura Kathryn Blank, CRNA
• Matthew William Blanke, PA-C

• Clinical Social Worker in Lancaster, PA
• Providers in Lancaster, PA by specialty
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.