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General NPI Number Information
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NPI Number | 1770218067
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Entity Type | Individual
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Provider Name | STEPHEN MARK ROSENBLATT
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Gender | Male
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 4490 MARKET COMMONS DR UNIT 701
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City | FAIRFAX
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State | VA
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Zip | 22033-6051
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Country | US
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Telephone | 571-567-0308
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Fax |
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Provider Business Mailing Address
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Address Line | 4060 GATEWAY DR APT 5517
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City | FAIRFAX
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State | VA
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Zip | 22030-5063
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Country | US
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Telephone | 571-668-0732
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 0903003905
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License Number State | VA
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