Healthcare Provider Details

I. General information

NPI: 1265798748
Provider Name (Legal Business Name): ROCIO BLAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24422 AVENIDA DE LA CARLOTA STE 190
LAGUNA HILLS CA
92653-3634
US

IV. Provider business mailing address

538 MADISON LN
ELGIN IL
60123-2537
US

V. Phone/Fax

Practice location:
  • Phone: 800-801-9833
  • Fax:
Mailing address:
  • Phone: 847-873-9201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129266
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149017862
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: