Provider Demographics
NPI:1043470354
Name:TABARES, BLANCA ISELA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BLANCA
Middle Name:ISELA
Last Name:TABARES
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 1:5671 SANTA TERESA BLVD
Mailing Address - Street 2:SUITE105
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-6512
Mailing Address - Country:US
Mailing Address - Phone:408-284-2280
Mailing Address - Fax:408-754-0450
Practice Address - Street 1:5671 SANTA TERESA BLVD
Practice Address - Street 2:SUITE105
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-6512
Practice Address - Country:US
Practice Address - Phone:408-284-2280
Practice Address - Fax:408-754-0450
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA277751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ00543ZOtherMEDICARE
CAZZZ00543ZOtherMEDICARE