Provider Demographics
NPI:1255887691
Name:BLAKLEY, FRANCESCA R (ASW)
Entity type:Individual
Prefix:
First Name:FRANCESCA
Middle Name:R
Last Name:BLAKLEY
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:FRANCESCA
Other - Middle Name:R
Other - Last Name:GONNELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASW
Mailing Address - Street 1:1492 SALEM CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-3339
Mailing Address - Country:US
Mailing Address - Phone:707-874-8030
Mailing Address - Fax:
Practice Address - Street 1:2101 COURAGE DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6717
Practice Address - Country:US
Practice Address - Phone:707-784-8219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 72321104100000X
CAASW72321101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker