Individual
ERIC BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
51 MARKET ST, BANGOR, PA 18013-1901
(610) 588-9109
Mailing address
51 MARKET ST, BANGOR, PA 18013-1901
(610) 588-9109
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW130486
PA
Other
Enumeration date
11/07/2013
Last updated
11/07/2013
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