Provider Demographics
NPI:1497576979
Name:BLOCK, JESSICA L (PSYD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:L
Last Name:BLOCK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:327 E 34TH ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4943
Mailing Address - Country:US
Mailing Address - Phone:425-890-5876
Mailing Address - Fax:
Practice Address - Street 1:225 W 35TH ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1980
Practice Address - Country:US
Practice Address - Phone:646-775-6602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026202103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist