Provider Demographics
NPI:1700617537
Name:BLACH, CAROLINE ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:ELIZABETH
Last Name:BLACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 HAMPSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3153
Mailing Address - Country:US
Mailing Address - Phone:408-386-2338
Mailing Address - Fax:
Practice Address - Street 1:2323 HAMPSHIRE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3153
Practice Address - Country:US
Practice Address - Phone:408-386-2338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2632400103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool