Provider Demographics
NPI:1093423642
Name:TRUE NORTH STAR LICENSED CLINICAL SOCIAL WORKER PC
Entity Type:Organization
Organization Name:TRUE NORTH STAR LICENSED CLINICAL SOCIAL WORKER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:909-765-6196
Mailing Address - Street 1:4060 N 1ST AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-3508
Mailing Address - Country:US
Mailing Address - Phone:909-765-6196
Mailing Address - Fax:
Practice Address - Street 1:4060 N 1ST AVENUE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-3508
Practice Address - Country:US
Practice Address - Phone:909-765-6196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty