MEDICARE: MRS. IRENE JEANETTE BLANCO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW68073	CA

General Provider Information

NPI Number	:	1730202136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IRENE JEANETTE BLANCO LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1288
Second Line	:
City	:	MADERA
State	:	CA
Zip	:	93639-1288
Country	:	US
Telephone Number	:	559-395-0450
Fax Number	:	559-661-2818

Provider Business Practice Location Address
First Line	:	117 N R ST
Second Line	:
City	:	MADERA
State	:	CA
Zip	:	93637-4465
Country	:	US
Telephone Number	:	559-395-0450
Fax Number	:	559-661-2818

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	09/06/2024

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