Healthcare Provider Details

I. General information

NPI: 1891233797
Provider Name (Legal Business Name): ALBA LARISSA BLANDINO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2017
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 N DELAWARE AVE 6TH FLOOR
PHILADELPHIA PA
19125-4330
US

IV. Provider business mailing address

2918 POPLAR ST APT 3
PHILADELPHIA PA
19130-1130
US

V. Phone/Fax

Practice location:
  • Phone: 215-496-0707
  • Fax: 215-496-0742
Mailing address:
  • Phone: 215-380-6773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC009215
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: