Basic Information
| Provider Information | |||||||||
| NPI: | 1679823900 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLANCO-HERRADA | ||||||||
| FirstName: | CLARA | ||||||||
| MiddleName: | CONCEPCION | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 957 INDUSTRIAL RD STE B | ||||||||
| Address2: | |||||||||
| City: | SAN CARLOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940704152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156039906 | ||||||||
| FaxNumber: | 6506209549 | ||||||||
| Practice Location | |||||||||
| Address1: | 957 INDUSTRIAL RD STE B | ||||||||
| Address2: | |||||||||
| City: | SAN CARLOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940704152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156039906 | ||||||||
| FaxNumber: | 6506209549 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2012 | ||||||||
| LastUpdateDate: | 06/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 75318 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 113198 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.