Active NPI
Larry M. Ali Blake Jr., LCSW
- Clinical Social Worker
- Jersey City, NJ
National Provider Identifier
1720239726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 44SC00522800
- Practice address
- 75 Harrison Ave
First Floor
Jersey City, NJ 07304-2555 - Phone
- (201) 451-5425
- Fax
- (201) 451-7499
- NPI assigned
- Oct 8, 2008
- Last updated
- Oct 8, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 44SC00522800 | NJ | Primary |
Addresses
Primary practice location
75 Harrison Ave
First Floor
Jersey City, NJ 07304-2555
Mailing address
75 Harrison Ave
First Floor
Jersey City, NJ 07304-2555
Phone (201) 451-5425
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44SC00522800 | NJ | MD | Clinical Social Worker |
Organizations & group practices 3
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.
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-
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223424000000",
"number": "1720239726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 HARRISON AVE",
"address_2": "FIRST FLOOR",
"city": "JERSEY CITY",
"state": "NJ",
"postal_code": "073042555",
"telephone_number": "201-451-5425",
"fax_number": "201-451-7499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 HARRISON AVE",
"address_2": "FIRST FLOOR",
"city": "JERSEY CITY",
"state": "NJ",
"postal_code": "073042555",
"telephone_number": "201-451-5425",
"fax_number": "201-451-7499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAKE",
"first_name": "LARRY",
"middle_name": "M. ALI",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-10-08",
"last_updated": "2008-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NJ",
"license": "44SC00522800",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jersey City, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.