Provider Demographics
NPI:1477808145
Name:BLENDEN, JANIS CAROL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JANIS
Middle Name:CAROL
Last Name:BLENDEN
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 1:3356 LAUREL OAK ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6396
Mailing Address - Country:US
Mailing Address - Phone:954-609-0022
Mailing Address - Fax:954-965-7432
Practice Address - Street 1:3356 LAUREL OAK ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6396
Practice Address - Country:US
Practice Address - Phone:954-609-0022
Practice Address - Fax:954-965-7432
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW40981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical