Provider Demographics
NPI:1053496257
Name:BLOCK, SHARON ADELE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ADELE
Last Name:BLOCK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 S BLUE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-2872
Mailing Address - Country:US
Mailing Address - Phone:928-634-7870
Mailing Address - Fax:
Practice Address - Street 1:1 N WILLARD ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3651
Practice Address - Country:US
Practice Address - Phone:928-634-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-03761041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool