Individual
MRS. SUSAN L. BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 HOSPITAL DR, TOWANDA, PA 18848-9710
(570) 265-2191
(570) 265-0932
Mailing address
1 HOSPITAL DR, TOWANDA, PA 18848-9710
(570) 265-2191
(570) 265-0932
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW000195E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019298080002
—
PA
Enumeration date
02/09/2007
Last updated
07/09/2007
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