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Individual

DR. MICHAEL RICHARD BLACK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PSYD

Contact information

Practice address
3139 N LINCOLN AVE STE 221, CHICAGO, IL 60657-3122
(773) 458-0585
(999) 999-9999
Mailing address
2230 N KOSTNER AVE, CHICAGO, IL 60639-3532
(773) 278-2643
(999) 999-9999

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
071008134
IL

Other

Enumeration date
06/22/2011
Last updated
05/13/2022
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