Provider Demographics
NPI:1497985444
Name:BLANCHARD, YANINA GONZALES (PSYD)
Entity Type:Individual
Prefix:
First Name:YANINA
Middle Name:GONZALES
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 BEACON ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4905
Mailing Address - Country:US
Mailing Address - Phone:617-232-2435
Mailing Address - Fax:617-232-0078
Practice Address - Street 1:1371 BEACON ST
Practice Address - Street 2:SUITE 304
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4905
Practice Address - Country:US
Practice Address - Phone:617-232-2435
Practice Address - Fax:617-232-0078
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9900103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical