Provider Demographics
NPI:1962497388
Name:BLOCH, JAMES P (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:BLOCH
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 1:2100 GARDINER LN
Mailing Address - Street 2:NOLAN BUILDING SUITE 307
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2962
Mailing Address - Country:US
Mailing Address - Phone:502-456-1990
Mailing Address - Fax:502-473-0667
Practice Address - Street 1:2100 GARDINER LN
Practice Address - Street 2:NOLAN BUILDING SUITE 307
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2962
Practice Address - Country:US
Practice Address - Phone:502-456-1990
Practice Address - Fax:502-473-0667
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY22000000071711OtherANTHEM
KY22000000071711OtherANTHEM