Provider Demographics
NPI:1376748384
Name:BLOCH, CAROLE S (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:S
Last Name:BLOCH
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 EAST 95TH ST
Mailing Address - Street 2:#3E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-410-0467
Mailing Address - Fax:212-410-0467
Practice Address - Street 1:30 EAST 95TH ST
Practice Address - Street 2:#3E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-410-0467
Practice Address - Fax:212-410-0467
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1442235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist