Provider Demographics
NPI:1255653218
Name:BLOCK, NATALENA (LCSW)
Entity Type:Individual
Prefix:
First Name:NATALENA
Middle Name:
Last Name:BLOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NATALENA
Other - Middle Name:
Other - Last Name:BLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:64 GRESYSTONE RD.EXT
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:CT
Mailing Address - Zip Code:06782
Mailing Address - Country:US
Mailing Address - Phone:203-660-7459
Mailing Address - Fax:
Practice Address - Street 1:64 GREYSTONE ROAD EXT
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:CT
Practice Address - Zip Code:06782-2900
Practice Address - Country:US
Practice Address - Phone:203-660-7459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007209101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008037013Medicaid
CT008037013Medicaid