MEDICARE: STEPHANIE 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	101YM0800X	Mental Health Counselor	89023	CA

General Provider Information

NPI Number	:	1538552096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE BLANCO

Provider Business Mailing Address
First Line	:	PO BOX 280215
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91328-0215
Country	:	US
Telephone Number	:	818-527-3360
Fax Number	:

Provider Business Practice Location Address
First Line	:	606 N FIGUEROA ST APT 621
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-3651
Country	:	US
Telephone Number	:	818-527-3360
Fax Number	:

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

Provider Enumeration Date	:	03/09/2015
Last Update Date	:	01/27/2025

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Directions to “ STEPHANIE BLANCO ” Practice Location

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