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General NPI Number Information
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NPI Number | 1598094880
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Entity Type | Individual
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Provider Name | HEATH IAN BLOCH LCSW
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Gender | Male
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Dates
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Enumeration Date | 12/15/2009
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Last Update Date | 12/15/2009
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Provider Practice Location Address
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Address Line | 24302 NORTHERN BLVD
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City | DOUGLASTON
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State | NY
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Zip | 11362-1150
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Country | US
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Telephone | 718-423-6200
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Fax | 718-423-9762
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Provider Business Mailing Address
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Address Line | 526 E 20TH ST APT 8G
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City | NEW YORK
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State | NY
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Zip | 10009-1312
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Country | US
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Telephone | 917-842-8629
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 072020
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License Number State | NY
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