Provider Demographics
NPI:1629080551
Name:BLOCH, DIANE E (PHD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:E
Last Name:BLOCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 RITTENHOUSE SQ
Mailing Address - Street 2:APT. 301
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5837
Mailing Address - Country:US
Mailing Address - Phone:215-545-0225
Mailing Address - Fax:
Practice Address - Street 1:3900 WOODLAND AVE.
Practice Address - Street 2:PHILADELPHIA VA MEDICAL CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-823-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006706L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical