Provider Demographics
NPI:1124000591
Name:BLOCK, ROSLYN W (LCSW)
Entity Type:Individual
Prefix:
First Name:ROSLYN
Middle Name:W
Last Name:BLOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 FORDHAM RD
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-5803
Mailing Address - Country:US
Mailing Address - Phone:631-321-7011
Mailing Address - Fax:631-669-8532
Practice Address - Street 1:17 FORDHAM RD
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-5803
Practice Address - Country:US
Practice Address - Phone:631-321-7011
Practice Address - Fax:631-669-8532
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0314071103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical