MEDICARE: CARMEN BLANCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1235282682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN BLANCO

Provider Business Mailing Address
First Line	:	189 MONTAGUE ST
Second Line	:	SUITE 418
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3610
Country	:	US
Telephone Number	:	718-578-5625
Fax Number	:	718-875-6876

Provider Business Practice Location Address
First Line	:	1420 BUSHWICK AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-1422
Country	:	US
Telephone Number	:	718-453-2277
Fax Number	:	718-453-1489

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

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Directions to “ CARMEN BLANCO ” Practice Location

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