=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124055405
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANDRA S. ROSENBLATT, PH.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10755 FALLS RD SUITE 260
-----------------------------------------------------
City | LUTHERVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21093-4515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-486-7331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7909 WINTERSET AVE
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21208-3110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-486-7331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGIST
-----------------------------------------------------
Name | DR. SANDRA S. ROSENBLATT
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 410-486-7331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 01905
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------