Individual
JESSICA J BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
225 HUMPHREY RD STE 4, GREENSBURG, PA 15601-4571
(724) 832-9096
(724) 832-2249
Mailing address
225 HUMPHREY RD STE 4, GREENSBURG, PA 15601-4571
(724) 832-9096
(724) 832-2249
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS017812
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PS017812
COMMONWEALTH OF PENNSYLVANIA DEPT. OF STATE
PA
Enumeration date
03/09/2018
Last updated
06/16/2018
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