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General NPI Number Information
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NPI Number | 1578627121
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Entity Type | Individual
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Provider Name | MICHAEL BLATT LCSW
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | PREFERRED BEHAVIORAL HEALTH 1500 ROUTE 88
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City | BRICK
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State | NJ
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Zip | 08724
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Country | US
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Telephone | 732-458-1700
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Fax | 732-785-9500
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Provider Business Mailing Address
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Address Line | 205 DOVE COURT
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City | LANOKA HARBOR
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State | NJ
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Zip | 08734
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Country | US
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Telephone | 609-693-0342
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC00003400
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License Number State | NJ
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