Provider Demographics
NPI:1972529816
Name:BLANKMAN, STEVEN MICHAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MICHAEL
Last Name:BLANKMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-5902
Mailing Address - Country:US
Mailing Address - Phone:707-826-1207
Mailing Address - Fax:
Practice Address - Street 1:21 11TH ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-5902
Practice Address - Country:US
Practice Address - Phone:707-826-1207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY-6963103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA156518OtherVALUEOPTIONS
CA6152277OtherUSBHPC
CAPM0069630Medicaid
CAPM0069631Medicaid
CA00PL69630Medicare ID - Type UnspecifiedEUREKA OFFICE
CAPM0069630Medicaid