Provider Demographics
NPI:1841308756
Name:BLOCK, JOYCE (PHD)
Entity type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:
Last Name:BLOCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 NORTH MICHIGAN ST #208
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601
Mailing Address - Country:US
Mailing Address - Phone:574-233-9756
Mailing Address - Fax:
Practice Address - Street 1:300 NORTH MICHIGAN ST #208
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601
Practice Address - Country:US
Practice Address - Phone:574-233-9756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040673103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY8127OtherSTATE OF NY EDUCATION DEP
IN20040673OtherSTATE BD OF EXAMINERS LIC
NY8127OtherSTATE OF NY EDUCATION DEP
07444809Medicare UPIN