Provider Demographics
NPI:1700999851
Name:BLOSS, EDWARD ALAN (MSW/LCSW)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ALAN
Last Name:BLOSS
Suffix:
Gender:M
Credentials:MSW/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 LEHIGH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3853
Mailing Address - Country:US
Mailing Address - Phone:484-894-5129
Mailing Address - Fax:610-330-9981
Practice Address - Street 1:2030 LEHIGH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3853
Practice Address - Country:US
Practice Address - Phone:484-894-5129
Practice Address - Fax:610-330-9981
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0134381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical