ETOSHA MARIE BLANK
NPI 1780222869
Counselor - Mental Health in Brooklyn, NY
About Etosha Marie Blank NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ETOSHA MARIE 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
Specialties & Licenses 2
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Etosha Marie Blank is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
2Medicare enrollment records show Etosha Blank reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
New York, NY 10025
- Reassigned Medicare billing, New York enrollment
- 94 clinicians in this Medicare group
San Francisco, CA 94131
- Reassigned Medicare billing, North Carolina enrollment
- Medicare enrollment name: Brightside Medical Of New Jersey PC
- 112 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
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.
Where is Etosha Blank located?
Etosha Blank practices at 705 Manhattan Ave, Brooklyn, NY 11222. The listed phone number is (347) 474-8464.
What is Etosha Blank's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.
Is Etosha Blank enrolled in Medicare?
Yes. Etosha Blank is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Etosha Blank's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Etosha Blank reassigns Medicare benefits to 2 organizations: Talkspace Medical Services Ny PC (New York, NY) and Brightside Medical Of New Jersey, P.C. (San Francisco, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Etosha Blank's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Etosha Blank accept?
Health plans from Blue Cross and Blue Shield of NC and Blue Cross and Blue Shield of Texas list Etosha Blank as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Etosha Blank was last updated on August 19, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months 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.
# Etosha Marie Blank · NPI 1780222869
Mental Health provider in Brooklyn, New York. Individual provider, active in the CMS NPPES registry since December 19, 2019.
## Identity
- **NPI:** 1780222869 (Entity type: Individual)
- **Enumerated:** December 19, 2019
- **Primary specialty:** Counselor - Mental Health · taxonomy 101YM0800X
- **State license:** 012547 (New York)
- **Sole proprietor:** No
## Practice location
- **Address:** 705 MANHATTAN AVE, Brooklyn, NY 11222-2909
- **Phone:** (347) 474-8464
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Talkspace Medical Services Ny PC (NPI 1790475556, New York, NY); Brightside Medical Of New Jersey, P.C. (NPI 1811524754, San Francisco, CA) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2019
## Record status
- **NPPES last updated:** August 19, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1780222869) · Data from the CMS NPPES public registry.