Provider Demographics
NPI:1710518410
Name:MORALES SANCHEZ, BLANCA M
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:M
Last Name:MORALES SANCHEZ
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 1:6831 SW 147TH AVE APT 4G
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1009
Mailing Address - Country:US
Mailing Address - Phone:786-712-7394
Mailing Address - Fax:
Practice Address - Street 1:6831 SW 147TH AVE APT 4G
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1009
Practice Address - Country:US
Practice Address - Phone:786-712-7394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-105036106S00000X
FL1-21-51206103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104818200Medicaid