Provider Demographics
NPI:1619740776
Name:MIDENCE, BLANCA MARINEE
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:MARINEE
Last Name:MIDENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 VILLAGE BLVD APT 1816
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-2793
Mailing Address - Country:US
Mailing Address - Phone:305-783-4679
Mailing Address - Fax:
Practice Address - Street 1:1401 VILLAGE BLVD APT 1816
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-2793
Practice Address - Country:US
Practice Address - Phone:305-783-4679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23307365103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst