Organization
ILENE BLAISCH
Active
Organization
ILENE BLAISCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ILENE BLAISCH LCSW (PSYCHOTHERAPIST)
(949) 910-5654
Entity
Organization
Contact information
Practice address
161 AVENIDA CABRILLO, SAN CLEMENTE, CA 92672-4040
(949) 910-5654
Mailing address
161 AVENIDA CABRILLO, SAN CLEMENTE, CA 92672-4040
(949) 910-5654
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
12/18/2009
Last updated
12/18/2009
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