Provider Demographics
NPI:1407249790
Name:BLOH, GAYNELLE CLARETTE (BCBA)
Entity Type:Individual
Prefix:MS
First Name:GAYNELLE
Middle Name:CLARETTE
Last Name:BLOH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:GAYNELLE
Other - Middle Name:CLARETTE
Other - Last Name:PEEBLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:132 FLEMING ST
Mailing Address - Street 2:
Mailing Address - City:BLANDON
Mailing Address - State:PA
Mailing Address - Zip Code:19510-9598
Mailing Address - Country:US
Mailing Address - Phone:215-370-9229
Mailing Address - Fax:
Practice Address - Street 1:132 FLEMING ST
Practice Address - Street 2:
Practice Address - City:BLANDON
Practice Address - State:PA
Practice Address - Zip Code:19510-9598
Practice Address - Country:US
Practice Address - Phone:215-370-9229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002690103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABH002690OtherDEPARTMENT OF STATE