Healthcare Provider Details

I. General information

NPI: 1285552810
Provider Name (Legal Business Name): JENNIFER BLANCO NP IN PSYCHIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 BROADWAY FL 4
BROOKLYN NY
11249-6233
US

IV. Provider business mailing address

425 MAIN ST STE 209
RIDGEFIELD CT
06877-4511
US

V. Phone/Fax

Practice location:
  • Phone: 203-522-8127
  • Fax: 203-872-1312
Mailing address:
  • Phone: 203-522-8127
  • Fax: 203-872-1312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MARGARET BLANCO
Title or Position: OWNER
Credential: NP-P PMHNP -BC
Phone: 203-522-8127