Provider Demographics
NPI:1598490534
Name:BLOXOM, QUINCY M (DSW, MSW,CFSW)
Entity Type:Individual
Prefix:DR
First Name:QUINCY
Middle Name:M
Last Name:BLOXOM
Suffix:
Gender:M
Credentials:DSW, MSW,CFSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 HIGH ST UNIT 1443
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4565
Mailing Address - Country:US
Mailing Address - Phone:609-969-3068
Mailing Address - Fax:
Practice Address - Street 1:219 E BROADWAY
Practice Address - Street 2:ATTN: THE HUDDLE OF SOUTH JERSEY & ERASE THE DIVIDE
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079
Practice Address - Country:US
Practice Address - Phone:609-969-3068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No171400000XOther Service ProvidersHealth & Wellness Coach
No251K00000XAgenciesPublic Health or Welfare
No251V00000XAgenciesVoluntary or Charitable