Provider Demographics
NPI:1720482748
Name:BEJAR, LANDIS BLOCK (LMHC)
Entity type:Individual
Prefix:MRS
First Name:LANDIS
Middle Name:BLOCK
Last Name:BEJAR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:LANDIS
Other - Middle Name:CLEARY
Other - Last Name:BLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:353 LEXINGTON AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0941
Mailing Address - Country:US
Mailing Address - Phone:917-524-9031
Mailing Address - Fax:
Practice Address - Street 1:353 LEXINGTON AVE STE 200
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0977
Practice Address - Country:US
Practice Address - Phone:917-524-9031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP9745101YM0800X
NY008127101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health