Healthcare Provider Details

I. General information

NPI: 1417028564
Provider Name (Legal Business Name): DAVID L BLOCH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 GRAND AVE
MIDDLETOWN NY
10940-3925
US

IV. Provider business mailing address

52 GRAND AVE
MIDDLETOWN NY
10940-3925
US

V. Phone/Fax

Practice location:
  • Phone: 845-343-1685
  • Fax: 845-343-1685
Mailing address:
  • Phone: 845-343-1685
  • Fax: 845-343-1685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberNY010546
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberNY010546
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberNY010546
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberNY 010546
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberNY 010546
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberNY 010546
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberNY 010546
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: