Provider Demographics
NPI:1407995707
Name:BLOCH, ELEANOR L
Entity Type:Individual
Prefix:MS
First Name:ELEANOR
Middle Name:L
Last Name:BLOCH
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 1:439 ANTHWYN RD
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072
Mailing Address - Country:US
Mailing Address - Phone:610-660-0879
Mailing Address - Fax:
Practice Address - Street 1:29 BALA AVE
Practice Address - Street 2:SUITE 224
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3209
Practice Address - Country:US
Practice Address - Phone:610-405-0238
Practice Address - Fax:610-667-7141
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
PACW004967L106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA655777OtherMEDICARE