Provider Demographics
NPI:1851422943
Name:BLATT, DARREN MICHAEL (MA, MFT-I)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:MICHAEL
Last Name:BLATT
Suffix:
Gender:M
Credentials:MA, MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 FLYNN ROAD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012
Mailing Address - Country:US
Mailing Address - Phone:805-914-1222
Mailing Address - Fax:805-482-0987
Practice Address - Street 1:975 FLYNN ROAD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012
Practice Address - Country:US
Practice Address - Phone:805-914-1222
Practice Address - Fax:805-482-0987
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45755106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist