KATIE BLAKE LCSW
NPI 1104375393
Social Worker - Clinical in Santa Rosa, CA

Q: What is Katie Blake's NPI number?

The NPI number for Katie Blake is 1104375393. It was assigned to this individual provider in the NPPES registry on September 28, 2016. The provider is also known as Kate Blake Lcsw.

Q: What is Katie Blake's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Q: When was this NPI record last updated?

The NPPES record for Katie Blake was last updated on April 13, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 28, 2016PECOS Enrolled

2225 CHALLENGER WAY, SANTA ROSA, CA 95407(707) 483-0588 Get Directions Write a Review

NPPES record last updated: April 13, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Apr 13, 2023, May 24, 2021, Sep 16, 2020 and 2 more (5 updates tracked since 2016).

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About Katie Blake Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KATIE BLAKE LCSW (NPI 1104375393) is an individual clinical provider in Santa Rosa, California, licensed in California (93792) and active in the NPI registry since September 2016. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1104375393

Entity TypeIndividualFemale

Primary Taxonomy1041C0700X

Provider Legal NameKATIE BLAKECredential: LCSW

Location Address2225 CHALLENGER WAYSanta Rosa, CA 95407-5441

Mailing Address1275 4th St # 4011Santa Rosa, CA 95404-4057 · (707) 908-9790

Phone(707) 483-0588

Sole ProprietorNo

Enumeration DateSeptember 28, 2016

Last NPPES UpdateApril 13, 20235 updates tracked since enumeration

NPPES CertifiedApril 13, 2023

✔ NPI 1104375393 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code1041C0700X

License✔ Licensed in CA · 93792

Definition

A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

2225 CHALLENGER WAY, Santa Rosa, CA 95407

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Other Names 1

Other Name (5)Kate Blake Lcsw

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Katie Blake Lcsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Katie Blake reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Permanente Medical Group Inc

34 mi

Internal Medicine

975 SERENO DRIVE
Vallejo, CA 94589

Reassigned Medicare billing, California enrollment
20,078 clinicians in this Medicare group

NPI 1336222397 (707) 651-1000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95407 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$0.00 typical visit price

range $63.04 – $187.01

Typical copayment $0.00 (range $15.76 – $46.75)

Most-billed visit code NA

Established Patient

$77.94 typical visit price

range $21.02 – $153.40

Typical copayment $19.48 (range $5.25 – $38.35)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RACHEL J AVILA

Counselor (Addiction (Substance Use Disorder))