Provider Demographics
NPI:1932476058
Name:BLANCO NEUROFEEDBACK INSTITUTE
Entity Type:Organization
Organization Name:BLANCO NEUROFEEDBACK INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REGLA
Authorized Official - Middle Name:JOSEFINA
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-785-6610
Mailing Address - Street 1:1416 SANTA CRUZ AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2258
Mailing Address - Country:US
Mailing Address - Phone:305-785-6610
Mailing Address - Fax:
Practice Address - Street 1:1416 SANTA CRUZ AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2258
Practice Address - Country:US
Practice Address - Phone:305-785-6610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8399103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty