Provider Demographics
NPI:1912094202
Name:DEBLOCK, DONALD (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:DEBLOCK
Suffix:
Gender:M
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:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:WENHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01984-2567
Mailing Address - Country:US
Mailing Address - Phone:978-468-7671
Mailing Address - Fax:978-468-9720
Practice Address - Street 1:135 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WENHAM
Practice Address - State:MA
Practice Address - Zip Code:01984
Practice Address - Country:US
Practice Address - Phone:978-468-7671
Practice Address - Fax:978-468-9720
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4602103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO4426OtherBLUE CROSS/BLUE SHIELD
MAWO4426OtherBLUE CROSS/BLUE SHIELD