Healthcare Provider Details

I. General information

NPI: 1851422943
Provider Name (Legal Business Name): DARREN MICHAEL BLATT MA, MFT-I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 FLYNN ROAD
CAMARILLO CA
93012
US

IV. Provider business mailing address

975 FLYNN ROAD
CAMARILLO CA
93012
US

V. Phone/Fax

Practice location:
  • Phone: 805-914-1222
  • Fax: 805-482-0987
Mailing address:
  • Phone: 805-914-1222
  • Fax: 805-482-0987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number45755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: