Provider Demographics
NPI:1427055680
Name:ROCK, TANYA JOYCE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:JOYCE
Last Name:ROCK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:JOYCE
Other - Last Name:BLACKMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1921 MARSAC ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-8525
Mailing Address - Country:US
Mailing Address - Phone:989-619-8910
Mailing Address - Fax:
Practice Address - Street 1:5375 E SANDY TRL
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:MI
Practice Address - Zip Code:49709-8956
Practice Address - Country:US
Practice Address - Phone:989-785-4444
Practice Address - Fax:989-785-4444
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-02
Last Update Date:2016-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010664001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1726Medicaid
MABLACK-0013Medicaid
MI119754(MHS)OtherVALUE OPTIONS
MA800008513OtherRAILROAD MEDICARE PROVIDE
MICOUN04-99298Medicaid
MI80-0-89-3855-0OtherBCBS-MICHIGAN
MICOUN04-99298Medicaid