Provider Demographics
NPI:1447050521
Name:DE LA ROSA-HERNANDEZ, BLANCA ANDREA (MA)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:ANDREA
Last Name:DE LA ROSA-HERNANDEZ
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7739 SW CAPITOL HWY STE 260
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2571
Mailing Address - Country:US
Mailing Address - Phone:971-287-8733
Mailing Address - Fax:
Practice Address - Street 1:7739 SW CAPITOL HWY STE 260
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2571
Practice Address - Country:US
Practice Address - Phone:541-640-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR9169101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health