Provider Demographics
NPI:1285057042
Name:BLOCK, MICHELE (EDM CAGS)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:BLOCK
Suffix:
Gender:F
Credentials:EDM CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 CLAPBOARDTREE ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-1717
Mailing Address - Country:US
Mailing Address - Phone:781-461-0006
Mailing Address - Fax:781-461-8866
Practice Address - Street 1:789 CLAPBOARDTREE ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-1717
Practice Address - Country:US
Practice Address - Phone:781-461-0006
Practice Address - Fax:781-461-8866
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health