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NPI Code Detail

MEDICARE: MR. BENNETT ALAN BLATT LCSW-R

MEDICARE: MR. BENNETT ALAN BLATT LCSW-R
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
11041C0700XClinical Social WorkerR031403-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1031403OTHERNYSOCIAL WORK

General Provider Information

NPI Number : 1962707539
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BENNETT ALAN BLATT LCSW-R
Provider Business Mailing Address
First Line : 690 OCEAN PKWY APT 2A
Second Line :
City : BROOKLYN
State : NY
Zip : 11230-1128
Country : US
Telephone Number : 414-630-3477
Fax Number :
Provider Business Practice Location Address
First Line : 1268 E 14TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11230-5241
Country : US
Telephone Number : 414-630-3477
Fax Number : 718-382-0051
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2011
Last Update Date : 11/21/2022

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