Individual
DR. MIRELLE DAVIS BLOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
4305 N LINCOLN AVE STE A, CHICAGO, IL 60618-1807
(872) 226-2313
Mailing address
1031 WESLEY AVE, EVANSTON, IL 60202-1160
(872) 226-2313
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071010127
IL
Other
Enumeration date
10/10/2019
Last updated
10/10/2019
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