Provider Demographics
NPI:1356601637
Name:BLASKO, CARMINA (MA, LPC)
Entity type:Individual
Prefix:
First Name:CARMINA
Middle Name:
Last Name:BLASKO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:CARMINA
Other - Middle Name:
Other - Last Name:MARQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10537 KELOWNA VW
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-4520
Mailing Address - Country:US
Mailing Address - Phone:719-650-3921
Mailing Address - Fax:
Practice Address - Street 1:77 3RD ST STE 400
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8179
Practice Address - Country:US
Practice Address - Phone:719-259-4951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0012348101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional