Individual provider · NPI-1

Robert Quincy Blake, LMSW

Social Worker · Cedar Hill, TX

NPI number1891850558
StatusActive
Last updated in NPPESJun 5, 2012

Details

NPI
1891850558
Entity type
Individual (NPI-1)
Name
Mr. Robert Quincy Blake
Credential
LMSW
Sex
Male
Sole proprietor
Yes
Enumeration date
Dec 23, 2006
Last updated
Jun 5, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
104100000X Social Worker42060TXYes

Practice location

1204 Paul Dr
Cedar Hill, TX 75104-6216

Phone 972-948-1291

Mailing address

1204 Paul Dr
Cedar Hill, TX 75104-6216

Phone 972-291-6324

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