Mildred Johanna Blandino, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

24917 Issued in CA

Practice address

1650 Las Plumas Ave Ste K
San Jose, CA 95133-1657

Phone

(408) 272-6726

Fax

(408) 295-4081

NPI assigned

Mar 12, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mildred Johanan Mayorga Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1236816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1699916296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 LAS PLUMAS AVE STE K",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951331657",
            "telephone_number": "408-272-6726",
            "fax_number": "408-295-4081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 LAS PLUMAS AVE STE K",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951331657",
            "telephone_number": "408-272-6726",
            "fax_number": "408-295-4081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANDINO",
        "first_name": "MILDRED",
        "middle_name": "JOHANNA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-12",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "24917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MILDRED",
            "last_name": "MAYORGA",
            "middle_name": "JOHANAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Erika Mary Blanchard
• Anjolie Blanco
• Janeth Nichole Blanco
• Michelle Louise Blanco
• Stefanie J Blanco, TEACHING CREDENTIAL
• Rhoda Blankenship
• Zoe Joann Blankenship
• Scott Blanton, PHD
• Venus Christine Abellada Blas, PA-C
• Amanda E Blass, M.ED., BCBA

• Clinical Social Worker in San Jose, CA
• Providers in San Jose, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.