Provider Demographics
NPI:1275010068
Name:BLISS, CAROL ELISABETH
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ELISABETH
Last Name:BLISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GEORGE RYDER RD S
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02633-1626
Mailing Address - Country:US
Mailing Address - Phone:215-514-6690
Mailing Address - Fax:
Practice Address - Street 1:100 GEORGE RYDER RD S
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:MA
Practice Address - Zip Code:02633-1626
Practice Address - Country:US
Practice Address - Phone:215-514-6690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1192841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical