Active NPI
Elizabeth Winton Blake, PH.D.
- Psychologist
- Fort Lauderdale, FL
National Provider Identifier
1326107426
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY4139
- Practice address
- 915 Middle River Dr
Suite 204
Fort Lauderdale, FL 33304-3559 - Phone
- (954) 763-6557
- Fax
- (954) 561-8331
- NPI assigned
- Dec 6, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY4139 | FL | Primary |
| Registered Nurse | 163W00000X | RN764412 | FL |
Addresses
Primary practice location
915 Middle River Dr
Suite 204
Fort Lauderdale, FL 33304-3559
Mailing address
915 Middle River Dr
Suite 204
Fort Lauderdale, FL 33304-3559
Phone (954) 763-6557
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 098581 | Other | FL | VALUE OPTIONS |
| 4278424 | Other | FL | AETNA |
| 299483 | Other | FL | AVMED HEALTH PLANS |
| 73460 | Other | FL | BLUE CROSS BLUE SHIELD |
| 084337 | Other | FL | MANAGED HEALTH NETWORK |
| BLAKELIZ | Other | FL | CORPHEALTH |
| IPO41451 | Other | FL | MAGELLAN BEHAVIORAL HEALT |
| 6110620 | Other | FL | UNITED BEHAVIORAL HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN764412 | FL | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1290038400000",
"number": "1326107426",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "915 MIDDLE RIVER DR",
"address_2": "SUITE 204",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333043559",
"telephone_number": "954-763-6557",
"fax_number": "954-561-8331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "915 MIDDLE RIVER DR",
"address_2": "SUITE 204",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333043559",
"telephone_number": "954-763-6557",
"fax_number": "954-561-8331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAKE",
"first_name": "ELIZABETH",
"middle_name": "WINTON",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-06",
"last_updated": "2010-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "FL",
"license": "PY4139",
"primary": true
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "FL",
"license": "RN764412",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "098581",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4278424",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AVMED HEALTH PLANS",
"identifier": "299483",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "73460",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MANAGED HEALTH NETWORK",
"identifier": "084337",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CORPHEALTH",
"identifier": "BLAKELIZ",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN BEHAVIORAL HEALT",
"identifier": "IPO41451",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIORAL HEALTH",
"identifier": "6110620",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Lauderdale, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.