Provider Demographics
NPI:1083899231
Name:ROSENBLATT, ROBERT GLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GLEN
Last Name:ROSENBLATT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 WISCONSIN AVE NW
Mailing Address - Street 2:SUITE 505
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-3603
Mailing Address - Country:US
Mailing Address - Phone:202-342-1142
Mailing Address - Fax:202-333-2525
Practice Address - Street 1:1010 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 505
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-3603
Practice Address - Country:US
Practice Address - Phone:202-342-1142
Practice Address - Fax:202-333-2525
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1811103TA0400X, 103TA0700X, 103TC1900X, 103TP2701X
MD2430103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1811OtherDC PROFESSIONAL LICENSING
MD2430OtherMARYLAND LICENSING BOARD
DC1811OtherDC PROFESSIONAL LICENSING