Provider Demographics
NPI:1235584129
Name:KHALIFEH, BLANCA LISBETH (LCSW)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:LISBETH
Last Name:KHALIFEH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BLANCA
Other - Middle Name:LISBETH
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1017 STANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-1523
Mailing Address - Country:US
Mailing Address - Phone:213-663-0325
Mailing Address - Fax:
Practice Address - Street 1:536 BELL STREET EXT
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-8704
Practice Address - Country:US
Practice Address - Phone:213-663-0325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1013561041C0700X
101YM0800X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker