| NPI | 1841650272 |
|---|---|
| Former Name | JACQUELINE BLAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 098376) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 097069) |
| Enumeration Date | 2016-02-26 |
| Last Update Date | 2024-09-20 |