MEDICARE: JESSICA BLOCK PH.D.

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	103TC0700X	Clinical Psychologist	100133-01	NY

General Provider Information

NPI Number	:	1750931929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA BLOCK PH.D.

Provider Business Mailing Address
First Line	:	2-12 W PARK AVE STE 200
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2-12 W PARK AVE STE 200
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2020
Country	:	US
Telephone Number	:	516-889-2332
Fax Number	:

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

Provider Enumeration Date	:	09/18/2019
Last Update Date	:	09/18/2019

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Directions to “ JESSICA BLOCK PH.D.” Practice Location

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