Provider Demographics
NPI:1790963213
Name:BLOCK, DALE A (LMFT CAP)
Entity Type:Individual
Prefix:MS
First Name:DALE
Middle Name:A
Last Name:BLOCK
Suffix:
Gender:F
Credentials:LMFT CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2688 FRUITVILLE ROAD
Mailing Address - Street 2:JFCS
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237
Mailing Address - Country:US
Mailing Address - Phone:949-366-2224
Mailing Address - Fax:949-366-2982
Practice Address - Street 1:2688 FRUITVILLE ROAD
Practice Address - Street 2:JFCS
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237
Practice Address - Country:US
Practice Address - Phone:949-366-2224
Practice Address - Fax:949-366-2982
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1775106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist