Healthcare Provider Details

I. General information

NPI: 1073228375
Provider Name (Legal Business Name): CAROLE BLANCHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4537 EDWARDS LN
CASTRO VALLEY CA
94546-4734
US

IV. Provider business mailing address

PO BOX 20244
CASTRO VALLEY CA
94546-8244
US

V. Phone/Fax

Practice location:
  • Phone: 510-690-1330
  • Fax: 510-690-1331
Mailing address:
  • Phone: 510-363-6938
  • Fax: 510-690-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: