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Individual

SHANTE BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1178 BROADWAY FL 3, NEW YORK, NY 10001-5666
(917) 284-9393
(917) 284-9393
Mailing address
1178 BROADWAY FL 3, NEW YORK, NY 10001-5666
(917) 284-9393
(917) 284-9393

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
103K00000X
Behavior Analyst
Primary
999
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
110026265E
MA
Enumeration date
02/03/2017
Last updated
04/22/2025
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