Linda Susanne Blake, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1030914 Issued in MA

Practice address

19029 US Highway 19 North, Villa 22D
Clearwater, FL 33764

Phone

(508) 369-0202

NPI assigned

Aug 31, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1535673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535673600000",
    "number": "1215419791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19029 US HIGHWAY 19 NORTH, VILLA 22D",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "33764",
            "telephone_number": "508-369-0202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19029 US HIGHWAY 19 NORTH, VILLA 22D",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "33764",
            "telephone_number": "508-369-0202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "LINDA",
        "middle_name": "SUSANNE",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-31",
        "last_updated": "2018-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "1030914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Black
• Emmett Andrew Blahnik, DC
• Lakeisha Joyce Blair-Watson, M.D.
• Jayla Nicole Blair
• Nancy Carol Blair, CCC-SLP
• Richard Wayne Blake, DDS PA
• Sonny James Blake, LMHC
• Joseph Antony Blanchette, LMHC
• Brie Blankenship, MA
• Reece Blankenship, PA-C

• Clinical Social Worker in Clearwater, FL
• Providers in Clearwater, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2018; 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.