Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | CW017247 | PA |
NPI | 1003082462 |
---|---|
Provider Name | Dr. Erica D Goldblatt |
First Address | Philadelphia, PA 19106-3763 |
Second Address | Philadelphia, PA 19106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2008 |
Last Update Date | 05/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CW017247 | STATE BOARD OF SOCIAL WORKERS (01) | PA |