Provider Demographics
NPI:1518560051
Name:SAMANTHA TARCOV BLOCK, LICSW LLC
Entity Type:Organization
Organization Name:SAMANTHA TARCOV BLOCK, LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICSW
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:TARCOV
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:781-222-8035
Mailing Address - Street 1:55 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3217
Mailing Address - Country:US
Mailing Address - Phone:781-222-8035
Mailing Address - Fax:
Practice Address - Street 1:55 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3217
Practice Address - Country:US
Practice Address - Phone:781-222-8035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty