Individual
AMY KRISTIN BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
5000 S 5TH AVE, HINES, IL 60141-3030
(708) 202-7816
Mailing address
3342 N OAKLEY AVE APT 3N, CHICAGO, IL 60618-6235
(312) 231-8593
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.022647
IL
Other
Enumeration date
11/01/2021
Last updated
11/01/2021
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