Provider Demographics
NPI:1174958631
Name:BLOCH MILLER, SOPHIE E (LCSW)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:E
Last Name:BLOCH MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 W 13TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3675
Mailing Address - Country:US
Mailing Address - Phone:541-554-6743
Mailing Address - Fax:971-226-4452
Practice Address - Street 1:227 W 13TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3675
Practice Address - Country:US
Practice Address - Phone:541-554-6743
Practice Address - Fax:971-266-4452
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL71301041C0700X
WACG60392149101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty