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 1:228 E 135TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-6433
Mailing Address - Country:US
Mailing Address - Phone:646-504-3291
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:2025-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101200000X, 171WH0202X, 1744R1102X, 225800000X, 251E00000X, 253Z00000X, 332U00000X, 372600000X, 376J00000X, 251S00000X
DC000856816106E00000X, 1744R1102X
NY7573977351744R1102X
GU547-897-1287405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101200000XBehavioral Health & Social Service ProvidersDrama Therapist
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No171WH0202XOther Service ProvidersContractorHome Modifications
No1744R1102XOther Service ProvidersSpecialistResearch Study
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No332U00000XSuppliersHome Delivered Meals
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty