Provider Demographics
NPI:1386893105
Name:BLANCO, WENDY CONSUELO (LCSW)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:CONSUELO
Last Name:BLANCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:CONSUELO
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:13433 OLIVE DR.
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601
Mailing Address - Country:US
Mailing Address - Phone:213-268-9816
Mailing Address - Fax:
Practice Address - Street 1:13433 OLIVE DR.
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601
Practice Address - Country:US
Practice Address - Phone:213-268-9816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CA626931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker