Provider Demographics
NPI:1871801712
Name:ROSENBLATT, ELI P (LCSW)
Entity type:Individual
Prefix:
First Name:ELI
Middle Name:P
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 1:648 MAPLE ST
Mailing Address - Street 2:2A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1204
Mailing Address - Country:US
Mailing Address - Phone:917-494-8787
Mailing Address - Fax:
Practice Address - Street 1:1273 53RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3845
Practice Address - Country:US
Practice Address - Phone:718-435-5700
Practice Address - Fax:718-854-5495
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079688-11041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical