Provider Demographics
NPI:1356695738
Name:BLACKBURN, ROSSANA CATALINA (CDC)
Entity type:Individual
Prefix:MRS
First Name:ROSSANA
Middle Name:CATALINA
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:CDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14515 HAMLIN ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1608
Mailing Address - Country:US
Mailing Address - Phone:818-285-1900
Mailing Address - Fax:818-285-1906
Practice Address - Street 1:14515 HAMLIN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1608
Practice Address - Country:US
Practice Address - Phone:818-285-1900
Practice Address - Fax:818-285-1906
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CAAII053250318101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)