Individual
DR. JACQUELINE BLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
5190 NW 167TH ST STE 215, MIAMI LAKES, FL 33014-6338
(305) 456-4147
Mailing address
5190 NW 167TH ST STE 215, MIAMI LAKES, FL 33014-6338
(305) 456-4147
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY10958
FL
Other
Enumeration date
05/09/2022
Last updated
05/09/2022
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