Shirley Blake, BA LBSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6802080513 Issued in MI

Practice address

801 Hazen St
Paw Paw, MI 49079-2008

Phone

(269) 655-3337

Fax

(269) 657-3474

NPI assigned

Feb 27, 2023

Last updated

Feb 27, 2023By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

State licenses

Practice roles

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.

• Van Buren Community Mental Health Authority

  • Psychiatry Physician
  • Paw Paw, MI
  • NPI 1003878554
  NPD (past)

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

{
    "created_epoch": "1677456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677456000000",
    "number": "1386343408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 249",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490790249",
            "telephone_number": "269-657-5574",
            "fax_number": "269-657-3474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 HAZEN ST",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490792008",
            "telephone_number": "269-655-3337",
            "fax_number": "269-657-3474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "SHIRLEY",
        "credential": "BA LBSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-27",
        "last_updated": "2023-02-27",
        "certification_date": "2023-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6802080513",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimi Lee Beattie
• Amber Bemis
• Amanda Jane Bennett
• Tisha Lynn Benton, LLP
• Alyssa Danielle Blake
• Kathryn Sue Block
• Selah Marie Bollinger
• Leah D Boone
• John F Boothby, CRNA
• Lowell Abott Bouchard

• Social Worker in Paw Paw, MI
• Providers in Paw Paw, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2023; 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.