Provider Demographics
NPI:1104685841
Name:PHELPS, BLANCA ESTELA (ASW)
Entity type:Individual
Prefix:MS
First Name:BLANCA
Middle Name:ESTELA
Last Name:PHELPS
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:BLANCA
Other - Middle Name:ESTELA
Other - Last Name:GONZALEZ-PHELPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ASW
Mailing Address - Street 1:1670A BETA DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-7056
Mailing Address - Country:US
Mailing Address - Phone:832-567-2582
Mailing Address - Fax:
Practice Address - Street 1:2423 CAMINO DEL RIO S STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3734
Practice Address - Country:US
Practice Address - Phone:619-241-2309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1159281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical