Individual
MAUREEN M BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
120 PENN ST, BALTIMORE, MD 21201-1082
(410) 328-8336
(410) 328-4379
Mailing address
PO BOX 62063, BALTIMORE, MD 21264-2063
(410) 706-5181
(410) 706-5103
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
1367
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
737510700
—
MD
Enumeration date
06/12/2006
Last updated
02/06/2013
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