Provider Demographics
NPI:1225236755
Name:CARRILLO-SERRANO, BLANCA ALICIA (ASW)
Entity Type:Individual
Prefix:MRS
First Name:BLANCA
Middle Name:ALICIA
Last Name:CARRILLO-SERRANO
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 FISHER AVE
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-5511
Mailing Address - Country:US
Mailing Address - Phone:408-779-5100
Mailing Address - Fax:408-227-5470
Practice Address - Street 1:298 BERNAL RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1809
Practice Address - Country:US
Practice Address - Phone:408-629-0713
Practice Address - Fax:408-227-5470
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA204671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical