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Individual
STACEY DIANE BLACK
Active
Individual
STACEY DIANE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW-C
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
09944
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
121798
JOHN HOPKINS HEALTHCARE
MD
01
—
614441-01
BCBS
MD
01
—
PHCS 2233929
PHCS
MD
Enumeration date
08/10/2006
Last updated
07/09/2007
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