Provider Demographics
NPI:1730202136
Name:BLANCO, IRENE JEANETTE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:JEANETTE
Last Name:BLANCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1288
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93639-1288
Mailing Address - Country:US
Mailing Address - Phone:559-395-0450
Mailing Address - Fax:559-661-2818
Practice Address - Street 1:117 N R ST
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4465
Practice Address - Country:US
Practice Address - Phone:559-395-0450
Practice Address - Fax:559-661-2818
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW680731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical