Provider Demographics
NPI:1336834134
Name:BLANCO, CARLITA ANDREA (CR)
Entity Type:Individual
Prefix:
First Name:CARLITA
Middle Name:ANDREA
Last Name:BLANCO
Suffix:
Gender:F
Credentials:CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 MARION AVE APT 6E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-3863
Mailing Address - Country:US
Mailing Address - Phone:929-763-3582
Mailing Address - Fax:
Practice Address - Street 1:1460 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW
Practice Address - State:NY
Practice Address - Zip Code:10018
Practice Address - Country:US
Practice Address - Phone:646-504-3291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101200000X, 251E00000X, 251S00000X, 171WH0202X, 1744R1102X, 253Z00000X, 372600000X, 332U00000X, 376J00000X, 225800000X
DC000856816106E00000X, 1744R1102X
NY7573977351744R1102X
GU547-897-1287405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No101200000XBehavioral Health & Social Service ProvidersDrama Therapist
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No171WH0202XOther Service ProvidersContractorHome Modifications
No1744R1102XOther Service ProvidersSpecialistResearch Study
No253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion
No332U00000XSuppliersHome Delivered Meals
No376J00000XNursing Service Related ProvidersHomemaker
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty