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General NPI Number Information
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NPI Number | 1053618314
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Entity Type | Organization
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Legal Business Name | ELIZABETH LEE ROSENBLATT, PSYD, A PSYCHOLOGICAL CORPORATION
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 02/23/2011
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Provider Practice Location Address
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Address Line | 12405 VENICE BLVD 124
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City | LOS ANGELES
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State | CA
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Zip | 90066-3803
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Country | US
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Telephone | 310-502-1162
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Fax | 866-485-1162
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Provider Business Mailing Address
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Address Line | 12405 VENICE BLVD 124
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City | LOS ANGELES
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State | CA
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Zip | 90066-3803
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Country | US
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Telephone | 310-502-1162
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Fax | 866-485-1162
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH LEE ROSENBLATT
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Credential | PSYD
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Telephone | 310-502-1162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY21110
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License Number State | CA
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