Provider Demographics
NPI:1487764361
Name:BOCK, KARLA (LCSW)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:BOCK
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 1:168 STARKS ROAD
Mailing Address - Street 2:KARLA BOCK LCSW
Mailing Address - City:NEW SHARON
Mailing Address - State:ME
Mailing Address - Zip Code:04955-3240
Mailing Address - Country:US
Mailing Address - Phone:207-778-0300
Mailing Address - Fax:
Practice Address - Street 1:186 MAIN STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938
Practice Address - Country:US
Practice Address - Phone:207-778-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC10861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME212410099Medicaid
MEMM8213Medicare ID - Type Unspecified
R28575Medicare UPIN