Provider Demographics
NPI:1871616607
Name:BLANCO, REBEKA I
Entity type:Individual
Prefix:
First Name:REBEKA
Middle Name:I
Last Name:BLANCO
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 1:323 CALLE GRUS
Mailing Address - Street 2:URB. PARQUE DE ISLA VERDE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-1384
Mailing Address - Country:US
Mailing Address - Phone:787-791-0798
Mailing Address - Fax:
Practice Address - Street 1:323 CALLE GRUS
Practice Address - Street 2:URB. PARQUE DE ISLA VERDE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-1384
Practice Address - Country:US
Practice Address - Phone:787-791-0798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR57971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical