Provider Demographics
NPI:1891233797
Name:BLANDINO, ALBA LARISSA (LPC)
Entity Type:Individual
Prefix:
First Name:ALBA
Middle Name:LARISSA
Last Name:BLANDINO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2918 POPLAR ST
Mailing Address - Street 2:APT 3
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1130
Mailing Address - Country:US
Mailing Address - Phone:215-380-6773
Mailing Address - Fax:
Practice Address - Street 1:1080 N DELAWARE AVE
Practice Address - Street 2:6TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-4330
Practice Address - Country:US
Practice Address - Phone:215-496-0707
Practice Address - Fax:215-496-0742
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009215101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional