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NPI Code Detail

MEDICARE: TERRY JAVOIS-BLOCKER L.C.S.W.R

MEDICARE: TERRY JAVOIS-BLOCKER L.C.S.W.R
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
1104100000XSocial WorkerR046837-1NY

General Provider Information

NPI Number : 1942426036
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY JAVOIS-BLOCKER L.C.S.W.R
Provider Business Mailing Address
First Line : 17 DEVON PL
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10301-2012
Country : US
Telephone Number : 347-372-0725
Fax Number : 718-720-0174
Provider Business Practice Location Address
First Line : 17 DEVON PL
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10301-2012
Country : US
Telephone Number : 347-372-0725
Fax Number : 718-720-0174
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2007
Last Update Date : 05/02/2016

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