Individual
DR. JONATHAN R BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
2290 NW 2ND AVE, SUITE 7, BOCA RATON, FL 33431-7457
(561) 706-1004
Mailing address
7546 OAKBORO DR, LAKE WORTH, FL 33467-7504
(954) 629-8150
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY8145
FL
Other
Enumeration date
11/16/2010
Last updated
07/29/2014
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