| Mirelle D. Bloch, Psy.d., Llc | |
|
1328 Greenleaf St Unit 4 Evanston IL 60202-1153 | |
| (872) 226-2313 | |
| (312) 312-9675 |
| Full Name | Mirelle D. Bloch, Psy.d., Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1328 Greenleaf St Unit 4, Evanston, Illinois |
| Authorized Official Name and Position | Mirelle D Bloch (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 8722262313 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mirelle D. Bloch, Psy.d., Llc 1328 Greenleaf St Unit 4 Evanston IL 60202-1153 Ph: (872) 226-2313 | Mirelle D. Bloch, Psy.d., Llc 1328 Greenleaf St Unit 4 Evanston IL 60202-1153 Ph: (872) 226-2313 |
| NPI Number | 1700644655 |
|---|---|
| Provider Enumeration Date | 03/06/2024 |
| Last Update Date | 03/06/2024 |
| Certification Date | 03/06/2024 |
| Medicare PECOS PAC ID | 1759720774 |
|---|---|
| Medicare Enrollment ID | O20240423002783 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700644655 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Mirelle Davis Bloch |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881236917 PECOS PAC ID: 8022457043 Enrollment ID: I20240423002771 |
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