| Doctor Name: | MRS. MARY ELLEN BLAKE |
| NPI Number: | 1093875783 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPCC |
| License Number: | E345 |
| Business Practice Address: | Catholic Charities 4200 Park Ave 3rd Floor Ashtabula, OH - 44004 |
| Business Phone Number: | 4409922121 |
| Business Fax Number: | 4409925974 |
| Mailing Address: | 1120 Elk Dr, ASHTABULA |
| State: | OH |
| Postal Code: | 440042218 |
| Phone Number: | 4409647196 |
| Fax Number: | |
| NPI Enumeration Date: | 12/11/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | E345 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |