Healthcare Provider Details

I. General information

NPI: 1497985444
Provider Name (Legal Business Name): YANINA GONZALES BLANCHARD PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 08/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 BEACON ST SUITE 304
BROOKLINE MA
02446-4905
US

IV. Provider business mailing address

1371 BEACON ST SUITE 304
BROOKLINE MA
02446-4905
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-2435
  • Fax: 617-232-0078
Mailing address:
  • Phone: 617-232-2435
  • Fax: 617-232-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9900
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: