Provider Demographics
NPI:1801625686
Name:BLANCO, ANDREAH (MA)
Entity type:Individual
Prefix:MRS
First Name:ANDREAH
Middle Name:
Last Name:BLANCO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 W SUNSET RD APT 2108
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1743
Mailing Address - Country:US
Mailing Address - Phone:956-240-6344
Mailing Address - Fax:
Practice Address - Street 1:12175 NETWORK BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3413
Practice Address - Country:US
Practice Address - Phone:210-797-7181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-22-223213106S00000X
TX1-24-78266103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician