Provider Demographics
NPI:1225079767
Name:BLANCHARD, JOHN PAUL (LCSW, ACSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 21444 BOX 3530
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09705-1444
Mailing Address - Country:US
Mailing Address - Phone:314-566-5205
Mailing Address - Fax:
Practice Address - Street 1:SHAPE HEALTHCARE FACILITY
Practice Address - Street 2:
Practice Address - City:CASTEAU
Practice Address - State:HAINAUT
Practice Address - Zip Code:7010 SHAPE
Practice Address - Country:BE
Practice Address - Phone:314-566-5205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA32991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical