Provider Demographics
NPI:1619479524
Name:BLOCK, LAUREN TAYLOR
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:TAYLOR
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 1:24 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1421
Mailing Address - Country:US
Mailing Address - Phone:973-760-8624
Mailing Address - Fax:973-334-2880
Practice Address - Street 1:50 UPPER MONTCLAIR PLZ STE 205
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1320
Practice Address - Country:US
Practice Address - Phone:973-692-5662
Practice Address - Fax:973-334-2880
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052297001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty