Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MH12759 | FL |
N | 103TC1900X | Counseling Psychologist |
NPI | 1083071260 |
---|---|
Provider Name | Jon Goldblatt |
First Address | Coral Springs, FL 33071-4180 |
Second Address | Coral Springs, FL 33071-4180 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2016 |
Last Update Date | 31/05/2019 |