Individual
EMILY JESSICA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
172 LINCOLN STREET, WORCESTOR, MA 01605
(508) 770-0511
Mailing address
172 LINCOLN ST, WORCESTER, MA 01605-3750
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/25/2017
Last updated
08/25/2017
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