Provider Demographics
NPI:1801201736
Name:BLANCHETTE, ROBERT (MED; EDS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:BLANCHETTE
Suffix:
Gender:M
Credentials:MED; EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 E KEY AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-4883
Mailing Address - Country:US
Mailing Address - Phone:352-217-0131
Mailing Address - Fax:
Practice Address - Street 1:233 E KEY AVE APT 5
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-4883
Practice Address - Country:US
Practice Address - Phone:352-217-0131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS 1185103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool