Provider Demographics
NPI:1699506063
Name:BLANCHER, MARK WILLIAM
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:WILLIAM
Last Name:BLANCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 LA PUENTE RD
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-2964
Mailing Address - Country:US
Mailing Address - Phone:626-652-2740
Mailing Address - Fax:
Practice Address - Street 1:3044 LA PUENTE RD
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-2964
Practice Address - Country:US
Practice Address - Phone:626-652-2740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical