Provider Demographics
NPI:1255703831
Name:KAREN BLOCH, MFT
Entity type:Organization
Organization Name:KAREN BLOCH, MFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT SOLE PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:858-455-1355
Mailing Address - Street 1:3252 HOLIDAY CT
Mailing Address - Street 2:SUITE 227
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0027
Mailing Address - Country:US
Mailing Address - Phone:858-455-1355
Mailing Address - Fax:858-455-5556
Practice Address - Street 1:3252 HOLIDAY CT
Practice Address - Street 2:SUITE 227
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0027
Practice Address - Country:US
Practice Address - Phone:858-455-1355
Practice Address - Fax:858-455-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT38192106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty