Provider Demographics
NPI:1619957040
Name:BLOCH, EDWARD (LSCSW)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:BLOCH
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 W 6TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4304
Mailing Address - Country:US
Mailing Address - Phone:785-218-3965
Mailing Address - Fax:785-842-2750
Practice Address - Street 1:2619 W 6TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4304
Practice Address - Country:US
Practice Address - Phone:785-842-2752
Practice Address - Fax:785-842-2750
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCS 21321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS069666OtherBLUE CROSS BLUE SHIELD KS
KS200655550AMedicaid
KS069377Medicare ID - Type Unspecified