Provider Demographics
NPI:1174675193
Name:ROSENBLATT, RUTH ELLEN (LICSW)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ELLEN
Last Name:ROSENBLATT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 EASTBROOK RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-2048
Mailing Address - Country:US
Mailing Address - Phone:781-329-4579
Mailing Address - Fax:781-329-8631
Practice Address - Street 1:30 EASTBROOK RD
Practice Address - Street 2:SUITE 302
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-2048
Practice Address - Country:US
Practice Address - Phone:781-329-4579
Practice Address - Fax:781-329-8631
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAROP1259Medicare ID - Type Unspecified
MAPO6992Medicare ID - Type UnspecifiedMEDICARE