Brianna Marie Blake

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

003606 Issued in CT

Practice address

200 Retreat Avenue
Hartford Hospital Psychiatry Dept.
Hartford, CT 06106-3310

Phone

(860) 545-7203

NPI assigned

Nov 8, 2016

Last updated

Dec 5, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in CT

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

Locations

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

• Hartford Hospital

  • Surgery Physician
  • Hartford, CT
  • NPI 1407806391
  Medicare reassignment NPD
• Hartford Hospital

  • General Acute Care Hospital
  • Hartford, CT
  • NPI 1770696643
  Medicare reassignment NPD

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

{
    "created_epoch": "1478563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480896000000",
    "number": "1366984338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 RETREAT AVENUE",
            "address_2": "HARTFORD HOSPITAL PSYCHIATRY DEPT.",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061063310",
            "telephone_number": "860-545-7203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 RETREAT AVENUE",
            "address_2": "HARTFORD HOSPITAL PSYCHIATRY DEPT.",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061063310",
            "telephone_number": "860-545-7203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "BRIANNA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-08",
        "last_updated": "2016-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "003606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nadine Lorraine Blackwood
• Raymond Michael Blair
• Sherry Sanderson Blair, APRN
• Darshana Blaise, MD
• Adriana Blakaj, M.D., PH.D.
• Tonginetta Blake
• Jasmine L Blanchard
• Karen Blank, M.D.
• Cindy A Blasewitz, PAC
• Sonja Blasko, LPC

• Clinical Psychologist in Hartford, CT
• Providers in Hartford, CT by specialty
• Clinical Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.