Provider Demographics
NPI:1396021325
Name:BLANCO RODRIGUEZ, EDDA MARIA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:EDDA
Middle Name:MARIA
Last Name:BLANCO RODRIGUEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G 3 HUCAR ST
Mailing Address - Street 2:URB ESTANCIAS DEL GUAYABAL
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-9702
Mailing Address - Country:US
Mailing Address - Phone:787-217-9244
Mailing Address - Fax:
Practice Address - Street 1:2060 COLINA ST
Practice Address - Street 2:URB VALLE ALTO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-4139
Practice Address - Country:US
Practice Address - Phone:787-217-9244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR108971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical