Nicole E Blake, LCSW, LADC is a medicare enrolled "Social Worker - Clinical" provider in Westbrook, Maine. Her current practice location is
40 Brackett St Apt 3, Westbrook, Maine. You can reach out to her office (for appointments etc.) via phone at
(603) 860-4900.
Nicole E Blake is licensed to practice in Maine (license number LC21397) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1962022350.
Healthcare Provider's Profile
| Full Name | Nicole E Blake |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 40 Brackett St Apt 3, Westbrook, Maine |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1962022350
- Provider Enumeration Date: 04/25/2020
- Last Update Date: 10/30/2023
Medicare PECOS Information:
- PECOS PAC ID: 2062884166
- Enrollment ID: I20230220001028
Medical Identifiers
Medical identifiers for Nicole E Blake such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1962022350 | NPI | - | NPPES |
| 2077079813 | Other | | INDIV NPI |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | LC7566 (Maine) | Secondary |
| 1041C0700X | Social Worker - Clinical | 2905 (New Hampshire) | Secondary |
| 1041C0700X | Social Worker - Clinical | LC21397 (Maine) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Nicole E Blake allows following entities to bill medicare on her behalf.
| Entity Name | Counseling Associates Of New London Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1205055365
PECOS PAC ID: 0042369910
Enrollment ID: O20090526000101 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Nicole E Blake is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Nicole E Blake, LCSW, LADC
40 Brackett St Apt 3,
Westbrook, ME 04092-3383
Ph: (603) 860-4900 | Nicole E Blake, LCSW, LADC
40 Brackett St Apt 3,
Westbrook, ME 04092-3383
Ph: (603) 860-4900 |
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