Provider Demographics
NPI:1528473873
Name:TAVERA, BLANCA (LCSW)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:
Last Name:TAVERA
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 1687
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95077-1687
Mailing Address - Country:US
Mailing Address - Phone:831-768-9398
Mailing Address - Fax:831-768-7014
Practice Address - Street 1:1009 FREEDOM BLVD
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3263
Practice Address - Country:US
Practice Address - Phone:831-768-9398
Practice Address - Fax:831-768-7014
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW237961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical