MEDICARE: BETH ROSENBLATT MFT-ATR

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	106H00000X	Marriage & Family Therapist	47857	CA

General Provider Information

NPI Number	:	1962762229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH ROSENBLATT MFT-ATR

Provider Business Mailing Address
First Line	:	13101 W WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5131
Country	:	US
Telephone Number	:	310-415-3416
Fax Number	:

Provider Business Practice Location Address
First Line	:	13101 W WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5131
Country	:	US
Telephone Number	:	310-415-3416
Fax Number	:

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

Provider Enumeration Date	:	05/21/2012
Last Update Date	:	05/21/2012

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