Provider Demographics
NPI:1619960572
Name:BLAHA, NANCY JANE (LCSW BCD)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:JANE
Last Name:BLAHA
Suffix:
Gender:F
Credentials:LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3653 COTTAGE DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-8617
Mailing Address - Country:US
Mailing Address - Phone:484-281-3109
Mailing Address - Fax:
Practice Address - Street 1:3653 COTTAGE DR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8617
Practice Address - Country:US
Practice Address - Phone:484-281-3109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW001727L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01091401OtherCAIC
PA00166Z6ZZOtherPERSONAL CHOICE
PABL633727Medicare ID - Type Unspecified
S14169Medicare UPIN