Provider Demographics
NPI:1831248806
Name:BLOCK, STACEY LYNN (LMSW, ACSW)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:BLOCK
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10434 ELGIN AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1504
Mailing Address - Country:US
Mailing Address - Phone:258-259-1407
Mailing Address - Fax:248-239-0652
Practice Address - Street 1:10434 ELGIN AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1504
Practice Address - Country:US
Practice Address - Phone:248-259-1407
Practice Address - Fax:248-239-0652
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010713061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical