Provider Demographics
NPI:1376304923
Name:BLANCO BEHAVIORAL HEALTH, A LICENSED CLINICAL SOCIAL WORKER CORP.
Entity Type:Organization
Organization Name:BLANCO BEHAVIORAL HEALTH, A LICENSED CLINICAL SOCIAL WORKER CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:CONSUELO
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:213-632-9117
Mailing Address - Street 1:13502 WHITTIER BLVD # H-156
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-1945
Mailing Address - Country:US
Mailing Address - Phone:213-632-9117
Mailing Address - Fax:
Practice Address - Street 1:13433 OLIVE DR
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4402
Practice Address - Country:US
Practice Address - Phone:213-632-9117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty