Provider Demographics
NPI:1538158019
Name:BLANCHARD, MARIE (DMH)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:DMH
Other - Prefix:DR
Other - First Name:C
Other - Middle Name:MARIE
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMH
Mailing Address - Street 1:6486 PLUMMER AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-3721
Mailing Address - Country:US
Mailing Address - Phone:510-790-0212
Mailing Address - Fax:
Practice Address - Street 1:3775 BEACON AVE
Practice Address - Street 2:#241
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1465
Practice Address - Country:US
Practice Address - Phone:510-790-0212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 8493103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL84930Medicare UPIN