Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | SW148 | FL |
NPI | 1003013475 |
---|---|
Provider Name | Mrs. Joanne Block |
First Address | Gainesville, FL 32606 |
Second Address | Gainesville, FL 32606-7432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 29/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Z-0961 | BCBS (01) | FL |