Provider Demographics
NPI:1316953060
Name:BLOCK, MAROLYN J (MS)
Entity type:Individual
Prefix:MRS
First Name:MAROLYN
Middle Name:J
Last Name:BLOCK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 COUNTRY CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3644
Mailing Address - Country:US
Mailing Address - Phone:832-721-3593
Mailing Address - Fax:281-242-1118
Practice Address - Street 1:2311 COUNTRY CLUB BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3644
Practice Address - Country:US
Practice Address - Phone:832-721-3593
Practice Address - Fax:281-242-1118
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4506101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health