Christopher V Blake, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

002120 Issued in CT

Practice address

64 Robbins St
Waterbury Hospital Crisis Center
Waterbury, CT 06708-2613

Phone

(203) 573-6103

Fax

(203) 573-7240

NPI assigned

Dec 19, 2011

Last updated

Dec 19, 2011By the provider in NPPES

Sex

Male

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

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1324252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324252800000",
    "number": "1386913416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 ROBBINS ST",
            "address_2": "WATERBURY HOSPITAL CRISIS CENTER",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082613",
            "telephone_number": "203-573-6103",
            "fax_number": "203-573-7240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64 ROBBINS ST",
            "address_2": "WATERBURY HOSPITAL CRISIS CENTER",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082613",
            "telephone_number": "203-573-6103",
            "fax_number": "203-573-7240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "CHRISTOPHER",
        "middle_name": "V",
        "name_prefix": "Mr.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-12-19",
        "last_updated": "2011-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "002120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Waterbury, CT
• Providers in Waterbury, CT by specialty
• Professional Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2011; 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.