Healthcare Provider Details

I. General information

NPI: 1982015178
Provider Name (Legal Business Name): ANNETTE BLANAS LCSW, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2014
Last Update Date: 05/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 DOLLY VARDEN AVE
ANCHORAGE AK
99516-1926
US

IV. Provider business mailing address

2117 DOLLY VARDEN AVE
ANCHORAGE AK
99516-1926
US

V. Phone/Fax

Practice location:
  • Phone: 907-345-8654
  • Fax:
Mailing address:
  • Phone: 907-345-8654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1256
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: