Provider Demographics
NPI:1629366570
Name:BOCK, RICHARD DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DAVID
Last Name:BOCK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 32ND ST
Mailing Address - Street 2:501
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3809
Mailing Address - Country:US
Mailing Address - Phone:212-253-2670
Mailing Address - Fax:
Practice Address - Street 1:2 W 32ND ST
Practice Address - Street 2:501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3809
Practice Address - Country:US
Practice Address - Phone:212-253-2670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8130-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist