Provider Demographics
NPI:1629228234
Name:BLANCO FONSECA, LIANA BEATRIZ (MSW)
Entity Type:Individual
Prefix:MISS
First Name:LIANA
Middle Name:BEATRIZ
Last Name:BLANCO FONSECA
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:URB. COVADONGA 3F-16 CALLE RECONQUISTA
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-5318
Mailing Address - Country:US
Mailing Address - Phone:787-612-4666
Mailing Address - Fax:
Practice Address - Street 1:URB. COVADONGA 3F-16 CALLE RECONQUISTA
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-5318
Practice Address - Country:US
Practice Address - Phone:787-612-4666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8736104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker