Provider Demographics
NPI:1104275650
Name:BLOCK, AMY (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BLOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MILLBURN AVE
Mailing Address - Street 2:SUITE 209A
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1737
Mailing Address - Country:US
Mailing Address - Phone:201-306-3758
Mailing Address - Fax:208-988-0230
Practice Address - Street 1:225 MILLBURN AVE
Practice Address - Street 2:SUITE 209A
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1737
Practice Address - Country:US
Practice Address - Phone:201-306-3758
Practice Address - Fax:208-988-0230
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC002976001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical