Provider Demographics
NPI:1598899510
Name:ROSENBLATT, ELIZABETH L (PSYD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:ROSENBLATT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3733 VETERAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-7012
Mailing Address - Country:US
Mailing Address - Phone:310-502-1162
Mailing Address - Fax:
Practice Address - Street 1:3733 VETERAN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-7012
Practice Address - Country:US
Practice Address - Phone:310-502-1162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21110103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical