Healthcare Provider Details

I. General information

NPI: 1376779082
Provider Name (Legal Business Name): JOWITA A BLOCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9027 SUTPHIN BLVD
JAMAICA NY
11435-3631
US

IV. Provider business mailing address

167 ROSE ST
FREEPORT NY
11520-4204
US

V. Phone/Fax

Practice location:
  • Phone: 718-526-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number076303
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: