MEDICARE: MS. BARBARA RAE BLOCK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R-043696	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	134074215	OTHER		FEDERAL TAX ID

General Provider Information

NPI Number	:	1053332718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA RAE BLOCK LCSW

Provider Business Mailing Address
First Line	:	420 COLUMBUS AVE STE 308
Second Line	:
City	:	VALHALLA
State	:	NY
Zip	:	10595-1382
Country	:	US
Telephone Number	:	914-773-1851
Fax Number	:	914-769-3156

Provider Business Practice Location Address
First Line	:	420 COLUMBUS AVE STE 308
Second Line	:
City	:	VALHALLA
State	:	NY
Zip	:	10595-1382
Country	:	US
Telephone Number	:	914-773-1851
Fax Number	:	914-769-3156

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	02/27/2019

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