Provider Demographics
NPI:1457452492
Name:BLATT, HOWARD N (LICSW, BCD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:N
Last Name:BLATT
Suffix:
Gender:M
Credentials:LICSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2505
Mailing Address - Country:US
Mailing Address - Phone:508-753-7140
Mailing Address - Fax:
Practice Address - Street 1:9 CEDAR ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2505
Practice Address - Country:US
Practice Address - Phone:508-753-7140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1060321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP03785Medicare ID - Type Unspecified