Individual
MR. NICHOLAS J. BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
350 MCNABB RD, MORIARTY, NM 87035
(505) 638-5491
(505) 638-5571
Mailing address
PO BOX 1395, MORIARTY, NM 87035-1395
(505) 832-4529
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
M-04746
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6281583
—
NM
Enumeration date
02/07/2007
Last updated
09/25/2007
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