Provider Demographics
NPI:1588900278
Name:WEISSBLATT, LARA MICHELLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LARA
Middle Name:MICHELLE
Last Name:WEISSBLATT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8461 LAKE WORTH RD STE 113
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2474
Mailing Address - Country:US
Mailing Address - Phone:561-223-4111
Mailing Address - Fax:
Practice Address - Street 1:8461 LAKE WORTH RD STE 461
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467
Practice Address - Country:US
Practice Address - Phone:561-223-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8683103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist