Nicole E Blake, LCSW, LADC
Individual provider Active NPI Clinical Social Worker · Westbrook, ME
NPI 1962022350 · NPPES record last updated Oct 30, 2023
Key facts
- NPI
- 1962022350
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- LC21397 (ME)
- Practice address
- 40 Brackett St Apt 3
Westbrook, ME 04092-3383 - Phone
- (603) 860-4900
- NPI assigned
- Apr 25, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC7566 | ME | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maine Medical Partners | Current |
Accepting new patients | |
| Spurwink Services Incorporated | Current |
Accepting new patients | |
| Maine Medical Partners | Current |
Accepting new patients |
Locations
139 State St
#1
Bangor, ME 04401
901 Washington Ave
Ste 100
Portland, ME 04103
Phone 20787112112145
1577 Congress St
Ste 2
Portland, ME 04102
Phone (207) 662-1622
9 Hillcrest Ave
Randolph, ME 04346
Phone (207) 582-9205
1 Harnois Ave
Ste 1A
Westbrook, ME 04092
Phone (207) 662-1360
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LC7566 | ME | |
| Clinical Social Worker | 1041C0700X | 2905 | NH | |
| Clinical Social Worker | 1041C0700X | LC21397 | ME | Yes |
Addresses
Primary practice location
40 Brackett St Apt 3
Westbrook, ME 04092-3383
Mailing address
40 Brackett St Apt 3
Westbrook, ME 04092-3383
Phone (603) 860-4900
Other practice location 1
35 Newport Rd
New London, NH 03257-5413
Phone (603) 865-1321
Other practice location 2
1577 Congress St Ste 2
Portland, ME 04102-2169
Phone (207) 662-5093
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2077079813 | Other | INDIV NPI |
Other names
- Nicole Jewell
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | nicole@mintconditioncounseling.com | Direct |
Other providers in Westbrook, ME
- Best Friend Home Care LLC
- Beyond Residential Care
- Karen Bickford
- Bio-Medical Applications of Maine, Inc.
- Emily Jordan Bisson
- Sarah Jane Blevins
- Blue Bliss Dental Wellness LLC.
- Abigail Whitman Blyler
- Kylie Ann Boivin
- Patrick James Boland
All providers in Westbrook, ME · Clinical Social Worker in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.