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General NPI Number Information
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NPI Number | 1801933718
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Entity Type | Individual
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Provider Name | MAXINE B BLOCK PH D
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Gender | Female
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 600 E GENESEE ST SUITE 217
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City | SYRACUSE
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State | NY
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Zip | 13202-3130
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Country | US
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Telephone | 315-422-0300
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Fax | 315-479-8455
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Provider Business Mailing Address
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Address Line | 600 E GENESEE ST SUITE 217
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City | SYRACUSE
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State | NY
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Zip | 13202-3130
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Country | US
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Telephone | 315-422-0300
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Fax | 315-479-8455
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 006555
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License Number State | NY
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