MEDICARE: MS. CYNTHIA IRENE ROSENBLATT CASAC, LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	12521	NY
2	101YM0800X	Mental Health Counselor	000814-1	NY

General Provider Information

NPI Number	:	1316244759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA IRENE ROSENBLATT CASAC, LMHC

Provider Business Mailing Address
First Line	:	100 ASCH LOOP
Second Line	:	APARTMENT 14B
City	:	BRONX
State	:	NY
Zip	:	10475-4010
Country	:	US
Telephone Number	:	718-862-0967
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 ASCH LOOP
Second Line	:	APARTMENT 14B
City	:	BRONX
State	:	NY
Zip	:	10475-4010
Country	:	US
Telephone Number	:	718-862-0967
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2011
Last Update Date	:	10/10/2012

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