Basic Information
| Provider Information | |||||||||
| NPI: | 1003013475 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLOCK | ||||||||
| FirstName: | JOANNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4131 N.W.. 28TH LANE | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523753001 | ||||||||
| FaxNumber: | 3523751003 | ||||||||
| Practice Location | |||||||||
| Address1: | 4131 NW 28TH LN | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326067432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523753001 | ||||||||
| FaxNumber: | 3523751003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2007 | ||||||||
| LastUpdateDate: | 08/29/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW148 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 106H00000X | MT107 | FL | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | Z-0961 | 01 | FL | BCBS | OTHER |