Provider Demographics
NPI:1043593023
Name:BLANCO, JOSE C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:C
Last Name:BLANCO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CARLO
Other - Middle Name:
Other - Last Name:BLANCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:B5 CALLE TABONUCO STE 203
Mailing Address - Street 2:GALERIA SAN PATRICIO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-3004
Mailing Address - Country:US
Mailing Address - Phone:787-906-9696
Mailing Address - Fax:
Practice Address - Street 1:B5 CALLE TABONUCO STE 203
Practice Address - Street 2:GALERIA SAN PATRICIO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-3004
Practice Address - Country:US
Practice Address - Phone:787-906-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2015-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8443OtherBEACON/BMC
MA1303295OtherMBHP