Healthcare Provider Details

I. General information

NPI: 1700917366
Provider Name (Legal Business Name): MICHAEL T. BLOCK LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 FAIRHARBOR DR
PATCHOGUE NY
11772-3342
US

IV. Provider business mailing address

233 FAIRHARBOR DR
PATCHOGUE NY
11772-3342
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-6492
  • Fax:
Mailing address:
  • Phone: 516-456-6282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR032673
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierR032673
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerSTATE LICENSE NUBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: