Individual
MS. ELLEN AUGUSTA BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
841 3RD AVE, DUNCANSVILLE, PA 16635-1424
(814) 515-4181
(814) 317-0348
Mailing address
841 3RD AVE, DUNCANSVILLE, PA 16635-1424
(814) 515-4181
(814) 317-0348
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
SW013281L
PA
1041C0700X
Clinical Social Worker
Primary
CW017179
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1021971500005
—
PA
Enumeration date
05/07/2008
Last updated
02/03/2024
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