Provider Demographics
NPI:1376797639
Name:BLECK, CARRIE JILL (LMSW)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:JILL
Last Name:BLECK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 CENTER LANE
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756
Mailing Address - Country:US
Mailing Address - Phone:516-796-6633
Mailing Address - Fax:516-796-6663
Practice Address - Street 1:152 CENTER LANE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756
Practice Address - Country:US
Practice Address - Phone:516-796-6633
Practice Address - Fax:516-796-6663
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076924104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker