Janice Blake, M.A.
Individual provider Active NPI Psychologist · Spencer, WV
NPI 1184770067 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1184770067
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 922 (WV)
- Practice address
- 141 Main St
Spencer, WV 25276-1414 - Phone
- (304) 927-5262
- Fax
- (304) 927-0378
- NPI assigned
- Jan 25, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- JC Edwards School of Medicine, Marshall University, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
315 Market St
Spencer, WV 25276-1811
Phone (304) 927-5262
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100128000049 | WV | Practitioner - Clinical Psychologist | 3678471372 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 922 | WV | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psych Services of Roane County | Psychologist | Current |
Accepting new patients |
| Psych Services Associates, Inc | Psychologist | Past | Accepting new patients |
Locations
315 Market St
Spencer, WV 25276
Phone (304) 927-5262
141 Main St
Spencer, WV 25276
Phone (304) 927-5262
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 922 | WV | Yes |
Addresses
Primary practice location
141 Main St
Spencer, WV 25276-1414
Mailing address
141 Main St
Spencer, WV 25276-1414
Phone (304) 927-5262
Other providers in Spencer, WV
- Dana Beaver
- Linda Beckett
- Rachel Kathryn Bennett
- Jessica Lynn Birkley
- Jennifer Renea Blair
- Destiny Blosser
- Madgelyn Board
- Tiffany Ann Board
- Alyssa Boggs
- Witney Faye Boswell
All providers in Spencer, WV · Psychologist in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.