Individual
MS. BEVERLY MARA BLATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC SLP
Contact information
Practice address
243 KING ST, SUITE 242, NORTHAMPTON, MA 01060-2451
(413) 584-0265
(413) 584-2031
Mailing address
20 W PARSONS LN, FLORENCE, MA 01062-3668
(413) 586-3039
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2556
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0395889
—
MA
Enumeration date
08/31/2006
Last updated
07/09/2007
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