Provider Demographics
NPI:1902331689
Name:TISHLER, BLAKE
Entity Type:Individual
Prefix:MR
First Name:BLAKE
Middle Name:
Last Name:TISHLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FREDERICK ABBOTT WAY
Mailing Address - Street 2:FRAMINGHAM CONTINUUM DEPT.
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-7992
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 FREDERICK ABBOTT WAY
Practice Address - Street 2:FRAMINGHAM CONTINUUM DEPT.
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-7992
Practice Address - Country:US
Practice Address - Phone:774-777-3125
Practice Address - Fax:774-777-3163
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor