Provider Demographics
NPI:1699942250
Name:GOLDBLATT, DEBRA (MFT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:GOLDBLATT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 MARIN ST
Mailing Address - Street 2:SUITE 234
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4261
Mailing Address - Country:US
Mailing Address - Phone:805-777-7113
Mailing Address - Fax:805-241-9878
Practice Address - Street 1:509 MARIN ST
Practice Address - Street 2:SUITE 234
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4261
Practice Address - Country:US
Practice Address - Phone:805-777-7113
Practice Address - Fax:805-241-9878
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37918101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health