Provider Demographics
NPI:1700188943
Name:ROSENBLATT, JUDITH SARA
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:SARA
Last Name:ROSENBLATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 MARINA BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-2068
Mailing Address - Country:US
Mailing Address - Phone:510-406-2578
Mailing Address - Fax:
Practice Address - Street 1:51 MARINA BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565
Practice Address - Country:US
Practice Address - Phone:510-406-2578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-20
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW60489104100000X
NY081869-1104100000X
CA650731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker