Jacob Michael Blank

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6352001031 Issued in MI

Practice address

32841 Middlebelt Rd Ste 403
Farmington Hills, MI 48334-1714

Phone

(248) 851-7739

NPI assigned

Oct 30, 2024

Sex

Male

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

State licenses

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.

• The Mel Bornstein Clinic for Psychoanalysis and Psychotherapy

  • Multi-Specialty Clinic/Center
  • Farmington Hills, MI
  • NPI 1023546389
  NPD

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

{
    "created_epoch": "1730246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1851113724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1085 KENYON DR",
            "city": "FORT WASHINGTON",
            "state": "PA",
            "postal_code": "190341625",
            "telephone_number": "215-816-1395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32841 MIDDLEBELT RD STE 403",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483341714",
            "telephone_number": "248-851-7739"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1945 Pauline Blvd Ste 21C",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481035021",
            "country_code": "US",
            "telephone_number": "248-851-7739",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLANK",
        "first_name": "JACOB",
        "middle_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-10-30",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6352001031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erwin Blandino
• Jameer Blaney
• Misty Blaney
• Elizabeth Blank
• Howard Stuart Blank, M.D.
• Seneca Blank
• Ashley Blankenship
• Clara Blankenship
• Miranda Blankenship
• Lanee Blanks

• Clinical Psychologist in Farmington Hills, MI
• Providers in Farmington Hills, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; 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.