Provider Demographics
NPI:1295052835
Name:SCHOCK, KEVEN MICKEL (MA)
Entity type:Individual
Prefix:MR
First Name:KEVEN
Middle Name:MICKEL
Last Name:SCHOCK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18654 NE FRANK WILLIAMS LN
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424-4451
Mailing Address - Country:US
Mailing Address - Phone:609-440-0418
Mailing Address - Fax:
Practice Address - Street 1:18654 NE FRANK WILLIAMS LN
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-4451
Practice Address - Country:US
Practice Address - Phone:609-440-0418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst