Provider Demographics
NPI:1033290630
Name:BLANSETT-MCALLISTER, SUSAN MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:BLANSETT-MCALLISTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 OCEANVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084
Mailing Address - Country:US
Mailing Address - Phone:760-809-9775
Mailing Address - Fax:858-605-9606
Practice Address - Street 1:250 EAST GRAND AVE
Practice Address - Street 2:ST B
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025
Practice Address - Country:US
Practice Address - Phone:760-809-9775
Practice Address - Fax:858-605-9606
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS112461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALSW11246Medicaid
CASW11246Medicare ID - Type Unspecified