Provider Demographics
NPI:1295718690
Name:BLATTER, CAROL WECHSLER (MSW)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:WECHSLER
Last Name:BLATTER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5655 E PASEO DE LA TIRADA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-1437
Mailing Address - Country:US
Mailing Address - Phone:520-577-0252
Mailing Address - Fax:520-529-4069
Practice Address - Street 1:40 N SWAN RD
Practice Address - Street 2:SUITE #111
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3018
Practice Address - Country:US
Practice Address - Phone:520-247-1031
Practice Address - Fax:520-529-4069
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-28931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ949919Medicaid
AZ949919Medicaid
AZ65949Medicare ID - Type Unspecified