Provider Demographics
NPI:1467893693
Name:BLASKOVICH, DAGNY (LCSW)
Entity Type:Individual
Prefix:
First Name:DAGNY
Middle Name:
Last Name:BLASKOVICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HARVEY WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2103
Mailing Address - Country:US
Mailing Address - Phone:831-425-8132
Mailing Address - Fax:831-425-4581
Practice Address - Street 1:300 HARVEY WEST BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2103
Practice Address - Country:US
Practice Address - Phone:831-425-8132
Practice Address - Fax:831-425-4581
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CAASW614971041C0700X
CALCSW881911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor