Provider Demographics
NPI:1962707539
Name:BLATT, BENNETT ALAN (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:BENNETT
Middle Name:ALAN
Last Name:BLATT
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 OCEAN PKWY APT 2A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1128
Mailing Address - Country:US
Mailing Address - Phone:414-630-3477
Mailing Address - Fax:
Practice Address - Street 1:1268 E 14TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5241
Practice Address - Country:US
Practice Address - Phone:414-630-3477
Practice Address - Fax:718-382-0051
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR031403-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY031403OtherSOCIAL WORK