Provider Demographics
NPI:1831228956
Name:BLOSE, STEFANIE L (MSW , LSW)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:L
Last Name:BLOSE
Suffix:
Gender:F
Credentials:MSW , LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PHILADELPHIA VA MEDICAL CENTER
Mailing Address - Street 2:UNIVERSITY & WOODLAND AVES
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-823-5800
Mailing Address - Fax:
Practice Address - Street 1:PHILADELPHIA VA MEDICAL CENTER
Practice Address - Street 2:UNIVERSITY & WOODLAND AVES
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-823-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW 1225971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical