MEDICARE: KAITLYN ROSENBLATT M.A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1528691078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN ROSENBLATT M.A

Provider Business Mailing Address
First Line	:	1550 FILLMORE ST APT 503
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3543
Country	:	US
Telephone Number	:	330-401-9127
Fax Number	:

Provider Business Practice Location Address
First Line	:	10926 DAVID TAYLOR DR # 120-101
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-1293
Country	:	US
Telephone Number	:	704-251-4898
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2020
Last Update Date	:	12/10/2025

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