Provider Demographics
NPI:1982015178
Name:BLANAS, ANNETTE (LCSW, BCBA)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:BLANAS
Suffix:
Gender:F
Credentials:LCSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 DOLLY VARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-1926
Mailing Address - Country:US
Mailing Address - Phone:907-345-8654
Mailing Address - Fax:
Practice Address - Street 1:2117 DOLLY VARDEN AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-1926
Practice Address - Country:US
Practice Address - Phone:907-345-8654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-10
Last Update Date:2014-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
AK12561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst