Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 9344 | MA |
NPI | 1073848016 |
---|---|
Provider Name | Dr. Ilana Blatt-Eisengart |
First Address | Salem, MA 01970-2141 |
Second Address | Salem, MA 01970-2141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2009 |
Last Update Date | 14/04/2011 |