Most Relevant Information
Provider Data
| NPI Number: | 1003827239 |
| Provider Name: | JEFFREY BLAKE LCSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | LC9874 |
Most Important Dates
| Enumeration Date: | 08/11/2006 |
| Last Updated: | 03/11/2013 |
Provider Practice Location
22 MONUMENT SQUARE
#403
PORTLAND
ME
041013914
Practice Location Phone/Fax
| Phone: | 2077499075 |
| Fax: |
Provider Mailing Location
22 MONUMENT SQ
#403
PORTLAND
ME
041014082
Provider Mailing Phone/Fax
| Phone: | 2077499075 |
| Fax: |