Provider Demographics
NPI:1831381276
Name:BLANCHARD, ANDREA PADILLA
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:PADILLA
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3122 N. MILLBROOK, SUITE A
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703
Mailing Address - Country:US
Mailing Address - Phone:559-225-9117
Mailing Address - Fax:559-225-9174
Practice Address - Street 1:3122 N MILLBROOK AVE STE A
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-1458
Practice Address - Country:US
Practice Address - Phone:559-225-9117
Practice Address - Fax:559-225-9174
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497803845OtherID