Provider Demographics
NPI:1144396540
Name:BOCK, BEATRICE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BEATRICE
Middle Name:
Last Name:BOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:BEATY
Other - Middle Name:
Other - Last Name:BOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:421 CHESTNUT ST
Mailing Address - Street 2:#303
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-2420
Mailing Address - Country:US
Mailing Address - Phone:215-923-0603
Mailing Address - Fax:856-797-6764
Practice Address - Street 1:2 EVES DR
Practice Address - Street 2:STE 104
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3193
Practice Address - Country:US
Practice Address - Phone:856-797-8777
Practice Address - Fax:856-797-6764
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC0020J0001041C0700X
PACW0125681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical