Provider Demographics
NPI:1386824340
Name:BLOCK, LEAH
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:BLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 TOWNLINE RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2827
Mailing Address - Country:US
Mailing Address - Phone:516-241-6465
Mailing Address - Fax:
Practice Address - Street 1:523 TOWNLINE RD
Practice Address - Street 2:SUITE 9
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2827
Practice Address - Country:US
Practice Address - Phone:516-241-6465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR039092-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical