Provider Demographics
NPI:1912109406
Name:BLASINI, AILEEN (MA)
Entity type:Individual
Prefix:MS
First Name:AILEEN
Middle Name:
Last Name:BLASINI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:AILEEN
Other - Middle Name:
Other - Last Name:BLASINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:URB. MANSIONES DE LOS CEDROS CAOBA ST
Mailing Address - Street 2:149
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736
Mailing Address - Country:US
Mailing Address - Phone:787-263-4822
Mailing Address - Fax:787-263-4822
Practice Address - Street 1:URB. CONDADO MODERNO, 13ST
Practice Address - Street 2:M-31
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-703-4050
Practice Address - Fax:787-703-4115
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2628103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent