Etosha Marie Blank

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

012547 Issued in NY

Practice address

705 Manhattan Ave
Brooklyn, NY 11222-2909

Phone

(347) 474-8464

NPI assigned

Dec 19, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Mental Health Counselor

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Talkspace Medical Services Ny PCGroup PAC ID 0143671966, 44 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Talkspace Medical Services Ny PC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • New York, NY
  • NPI 1790475556
  Medicare reassignment Care Compare group NPD
• Brooklyn Psychotherapy, LCSW, PC

  • Clinical Social Worker
  • Brooklyn, NY
  • NPI 1356746515
  NPD (past)

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

{
    "created_epoch": "1576713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787097600000",
    "number": "1780222869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 WINDRACE TRL",
            "city": "SANFORD",
            "state": "NC",
            "postal_code": "273328029",
            "telephone_number": "607-346-1473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 MANHATTAN AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112222909",
            "telephone_number": "347-474-8464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANK",
        "first_name": "ETOSHA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-19",
        "last_updated": "2026-08-19",
        "certification_date": "2026-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "23138",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "23138",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NY",
            "license": "012547",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "012547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marissa Blando, MS OTR/L
• Nicky Blando
• Abigail Jen Blank, MS
• Emil Blank, D.D.S
• Emily Blank
• Marsha Blank, L.C.S.W.
• Molly Blank, LMSW
• Sara Blank
• Grace Blanka, PA
• Judith Blanka, BCBA

• Mental Health Counselor in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.