Individual provider Active NPI

Anathaleo Blake, B.A.

  • Addiction (Substance Use Disorder) Counselor
  • Bronx, NY
National Provider Identifier
1992101141
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
38640-T Issued in NY
Practice address
3584 Jerome Ave
Bronx, NY 10467-1006
Phone
(718) 653-1537
Fax
(718) 228-6993
NPI assigned
Nov 17, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 38640-T NY Primary
Social Worker 104100000X

Addresses

Primary practice location

3584 Jerome Ave
Bronx, NY 10467-1006

Mailing address

79 Glenridge Rd
Glenville, NY 12302-4523

Other practice location 1

9114 37th Ave
Jackson Heights, NY 11372-7920
Phone (718) 779-1831

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
Credentials
Bachelor of Arts

State licenses

LicenseStateTypeSpecialty
38640-TNYMDAddiction (Substance Use Disorder) Counselor

NPI Registry JSON

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

{
    "created_epoch": "1416182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1992101141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79 GLENRIDGE RD",
            "city": "GLENVILLE",
            "state": "NY",
            "postal_code": "123024523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3584 JEROME AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104671006",
            "telephone_number": "718-653-1537",
            "fax_number": "718-228-6993"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9114 37th Ave",
            "address_purpose": "LOCATION",
            "city": "Jackson Heights",
            "state": "NY",
            "postal_code": "113727920",
            "country_code": "US",
            "telephone_number": "718-779-1831",
            "fax_number": "347-612-4150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "ANATHALEO",
        "name_prefix": "Mr.",
        "credential": "B.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-11-17",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "38640-T",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 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.