Provider Demographics
NPI:1902415631
Name:ROSENBLATT, SAMUEL (RMHCI, CPT)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:ROSENBLATT
Suffix:
Gender:M
Credentials:RMHCI, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 NE 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-2511
Mailing Address - Country:US
Mailing Address - Phone:352-448-9120
Mailing Address - Fax:
Practice Address - Street 1:1001 NE 16TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-2511
Practice Address - Country:US
Practice Address - Phone:352-448-9120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH19066101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
14925950OtherCAQH