MEDICARE: HANNAH GRACE ROSENBLATT LCSW

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	1041C0700X	Clinical Social Worker	10773	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508417056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH GRACE ROSENBLATT LCSW

Provider Business Mailing Address
First Line	:	400 COLUMBUS AVENUE
Second Line	:	CREDENTIALING SPECIALIST
City	:	NEW HAVEN
State	:	CT
Zip	:	06519-1233
Country	:	US
Telephone Number	:	203-503-3000
Fax Number	:	203-503-3183

Provider Business Practice Location Address
First Line	:	226 DIXWELL AVENUE
Second Line	:	NORTHSIDE
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-0651
Country	:	US
Telephone Number	:	203-503-3470
Fax Number	:	203-503-3478

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

Provider Enumeration Date	:	09/26/2019
Last Update Date	:	09/26/2019

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