Provider Demographics
NPI:1003082462
Name:GOLDBLATT, ERICA D (DSW, LCSW, MBE)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:D
Last Name:GOLDBLATT
Suffix:
Gender:F
Credentials:DSW, LCSW, MBE
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:GOLDBLATT
Other - Last Name:HYATT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DSW,LCSW, MBE
Mailing Address - Street 1:233 S 6TH ST STE C33
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3763
Mailing Address - Country:US
Mailing Address - Phone:267-324-9564
Mailing Address - Fax:
Practice Address - Street 1:233 S 6TH ST STE C33
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106
Practice Address - Country:US
Practice Address - Phone:267-324-9564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0172471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACW017247OtherSTATE BOARD OF SOCIAL WORKERS