Provider Demographics
NPI:1033312822
Name:BLOCK, WENDY NAN (LCS,W)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:NAN
Last Name:BLOCK
Suffix:
Gender:F
Credentials:LCS,W
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 KEMPTON DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-4622
Mailing Address - Country:US
Mailing Address - Phone:562-799-0747
Mailing Address - Fax:562-799-0747
Practice Address - Street 1:4132 KATELLA AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3426
Practice Address - Country:US
Practice Address - Phone:562-310-5505
Practice Address - Fax:562-799-0747
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS146431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical