MEDICARE: MS. AMIE KEYS 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	R0544321	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P2574757	OTHER	NY	OXFORD
2	319110	OTHER	NY	MHN

General Provider Information

NPI Number	:	1902019086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMIE KEYS BLOCK LCSW

Provider Business Mailing Address
First Line	:	145 HUDSON ST
Second Line	:	SUITE 6B
City	:	NEW YORK
State	:	NY
Zip	:	10013-2103
Country	:	US
Telephone Number	:	646-638-1701
Fax Number	:	646-638-1703

Provider Business Practice Location Address
First Line	:	145 HUDSON ST
Second Line	:	SUITE 6B
City	:	NEW YORK
State	:	NY
Zip	:	10013-2103
Country	:	US
Telephone Number	:	646-638-1701
Fax Number	:	646-638-1703

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/08/2007

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