Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 30 days.

ETOSHA BLANK
NPI 1780222869
Counselor - Mental Health in Brooklyn, NY

Q: What is Etosha Blank's NPI number?

The NPI number for Etosha Blank is 1780222869. It was assigned to this individual provider in the NPPES registry on December 19, 2019.

Q: What is Etosha Blank's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Q: When was this NPI record last updated?

The NPPES record for Etosha Blank was last updated on July 1, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since December 19, 2019PECOS EnrolledAccepts Medicare Assignment

705 MANHATTAN AVE, BROOKLYN, NY 11222(347) 474-8464 Get Directions Write a Review

NPPES record last updated: July 1, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: May 15, 2023, Dec 19, 2019 (2 updates tracked since 2019).

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About Etosha Blank NPPES

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

ETOSHA BLANK (NPI 1780222869) is an individual mental health provider in Brooklyn, New York, licensed in New York (012547) and active in the NPI registry since December 2019. She is enrolled in Medicare PECOS and is a graduate of Other (2019).

NPPES Registry Identity

NPI1780222869

Entity TypeIndividualFemale

Primary Taxonomy101YM0800X

Provider Legal NameETOSHA BLANK

Location Address705 MANHATTAN AVEBrooklyn, NY 11222-2909

Mailing Address1021 Windrace TrlSanford, NC 27332-8029 · (607) 346-1473

Phone(347) 474-8464

Sole ProprietorNo

Medical School CMSOtherGraduated 2019

Enumeration DateDecember 19, 2019

Last NPPES UpdateJuly 1, 20262 updates tracked since enumeration

NPPES CertifiedJuly 1, 2026

✔ NPI 1780222869 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

Licenses✔ Licensed in NY · 012547✔ Licensed in NC · 23138

Also ListedCounselor · ProfessionalTaxonomy 101YP2500X · License 23138 (NC), 012547 (NY)

705 MANHATTAN AVE, Brooklyn, NY 11222

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Etosha Blank is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4981149721

PECOS Enrollment IDI20240716003773

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.

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.

ANNA CALABRESE LMSW

Social Worker (Clinical)