Provider Demographics
NPI:1851481261
Name:BLOCH, NAOMI F (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NAOMI
Middle Name:F
Last Name:BLOCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:NAOMI
Other - Middle Name:JUDITH
Other - Last Name:FUIKELSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 DUSSAULT DR
Mailing Address - Street 2:
Mailing Address - City:LATHAU
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2303
Mailing Address - Country:US
Mailing Address - Phone:518-786-1540
Mailing Address - Fax:518-786-1540
Practice Address - Street 1:623 NEW LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110
Practice Address - Country:US
Practice Address - Phone:518-786-1540
Practice Address - Fax:518-786-1540
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSWR013962104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
55994BMedicare ID - Type Unspecified