Provider Demographics
NPI:1043719677
Name:BLOCK, KASSI JEAN (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:KASSI
Middle Name:JEAN
Last Name:BLOCK
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 BELLINO BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-0009
Mailing Address - Country:US
Mailing Address - Phone:219-928-0758
Mailing Address - Fax:
Practice Address - Street 1:140 WALLACE RD
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-8069
Practice Address - Country:US
Practice Address - Phone:904-544-5863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst