Daniel Blake, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301005841 Issued in MI

Practice address

26789 Woodward Ave
Huntington Woods, MI 48070-1335

Phone

(248) 398-3693

NPI assigned

Jun 16, 2006

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Interoperability endpoints

• Direct secure messaging: dblake1225868@epic00.shdirect.org
• Direct secure messaging: dblake100468@direct.beaumont.edu

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658448000000",
    "number": "1992749089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849",
            "telephone_number": "947-522-1865",
            "fax_number": "947-522-0307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26789 WOODWARD AVE",
            "city": "HUNTINGTON WOODS",
            "state": "MI",
            "postal_code": "480701335",
            "telephone_number": "248-398-3693"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "33155 Annapolis St",
            "address_purpose": "LOCATION",
            "city": "Wayne",
            "state": "MI",
            "postal_code": "481842405",
            "country_code": "US",
            "telephone_number": "734-467-4000",
            "fax_number": "734-467-4017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2022-07-22",
        "certification_date": "2022-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301005841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "DBLAKE100468@DIRECT.BEAUMONT.EDU",
            "affiliation": "N",
            "address_1": "33155 Annapolis St",
            "city": "Wayne",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481842405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Berkley Primary Care, PLC
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• Haden Bighouse
• Stacey Lynn Block, LMSW, ACSW
• Elaine Bloom
• Elaina Bluman, PT
• Melissa Borkin
• Russell Charles Bowman, DDS

• Clinical Psychologist in Huntington Woods, MI
• Providers in Huntington Woods, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2022; 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.