Provider Demographics
NPI:1538138425
Name:BLOCH, LINDA PHYLLIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:PHYLLIS
Last Name:BLOCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:BLOCH
Other - Last Name:KIRSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:120 ALLENS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3306
Mailing Address - Country:US
Mailing Address - Phone:585-271-7630
Mailing Address - Fax:585-271-6999
Practice Address - Street 1:120 ALLENS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3306
Practice Address - Country:US
Practice Address - Phone:585-271-7630
Practice Address - Fax:585-271-6999
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013166103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY105576FCMedicare UPIN
7272346Medicare UPIN