Provider Demographics
NPI:1871707471
Name:ROSENBLATT, DAVID RICHARD (LCSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RICHARD
Last Name:ROSENBLATT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5058 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2552
Mailing Address - Country:US
Mailing Address - Phone:847-674-6376
Mailing Address - Fax:847-674-6376
Practice Address - Street 1:5058 ELM STREET
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2552
Practice Address - Country:US
Practice Address - Phone:847-674-6376
Practice Address - Fax:847-674-6376
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical