Provider Demographics
NPI:1871624890
Name:BLOCK, DEBRA M (PSYD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:M
Last Name:BLOCK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 DUNDEE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2609
Mailing Address - Country:US
Mailing Address - Phone:224-226-5222
Mailing Address - Fax:224-213-7306
Practice Address - Street 1:2720 DUNDEE RD STE 210
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2609
Practice Address - Country:US
Practice Address - Phone:224-226-5222
Practice Address - Fax:224-213-7306
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006426103TB0200X, 103TH0100X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service