Provider Demographics
NPI:1205817640
Name:GOLDBLATT, CYNTHIA ANN (LPCC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANN
Last Name:GOLDBLATT
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:ANN
Other - Last Name:GOLDBLATT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC
Mailing Address - Street 1:835 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-3455
Mailing Address - Country:US
Mailing Address - Phone:505-747-7400
Mailing Address - Fax:505-747-7403
Practice Address - Street 1:835 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3455
Practice Address - Country:US
Practice Address - Phone:505-747-7400
Practice Address - Fax:505-747-7403
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM#0312101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health