Provider Demographics
NPI:1902091515
Name:BLANCO, YIARA S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:YIARA
Middle Name:S
Last Name:BLANCO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14448 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2612
Mailing Address - Country:US
Mailing Address - Phone:813-701-2471
Mailing Address - Fax:813-701-2471
Practice Address - Street 1:14448 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2612
Practice Address - Country:US
Practice Address - Phone:813-701-2471
Practice Address - Fax:813-701-2471
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist