Provider Demographics
NPI:1821081266
Name:GOLDBLATT, KATHLEEN M (LCSWR)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:GOLDBLATT
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8899 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7628
Mailing Address - Country:US
Mailing Address - Phone:716-510-0720
Mailing Address - Fax:
Practice Address - Street 1:8899 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7628
Practice Address - Country:US
Practice Address - Phone:716-510-0720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0466611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00025226001OtherUNIVERA
NY000526177001OtherBCBS OF WNY
NY00025226001OtherUNIVERA