Provider Demographics
NPI:1588082655
Name:GREENBLATT, LORI (MA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:GREENBLATT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 N FINDLEY ST STE F
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2064
Mailing Address - Country:US
Mailing Address - Phone:814-952-0417
Mailing Address - Fax:
Practice Address - Street 1:265 N FINDLEY ST STE F
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2064
Practice Address - Country:US
Practice Address - Phone:814-952-0417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007492101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional