Provider Demographics
NPI:1649572090
Name:GREENBLATT, EDWARD MACK (LMHC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:MACK
Last Name:GREENBLATT
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18011
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-0011
Mailing Address - Country:US
Mailing Address - Phone:206-774-9770
Mailing Address - Fax:
Practice Address - Street 1:3830 S FERDINAND ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1738
Practice Address - Country:US
Practice Address - Phone:206-774-9770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60195283101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health