Provider Demographics
NPI:1114038239
Name:BLATT, BEVERLY MARA (MA CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:MARA
Last Name:BLATT
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W PARSONS LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-3668
Mailing Address - Country:US
Mailing Address - Phone:413-586-3039
Mailing Address - Fax:
Practice Address - Street 1:243 KING ST
Practice Address - Street 2:SUITE 242
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2451
Practice Address - Country:US
Practice Address - Phone:413-584-0265
Practice Address - Fax:413-584-2031
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2556235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0395889Medicaid