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Individual

MISS KATIE MARIE BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSW

Contact information

Practice address
3900 BROADWAY STE B1, FORT MYERS, FL 33901-8193
(239) 939-2808
Mailing address
12339 WOODROSE CT APT 4, FORT MYERS, FL 33907-4634
(239) 560-8239

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
ISW4475
FL

Other

Enumeration date
02/22/2007
Last updated
07/08/2007
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