MEDICARE: BABE BLACK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114145513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BABE BLACK LCSW

Provider Business Mailing Address
First Line	:	8331 CRAWFORDSVILLE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-1715
Country	:	US
Telephone Number	:	317-296-4187
Fax Number	:

Provider Business Practice Location Address
First Line	:	3073 SALT LAKE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-1432
Country	:	US
Telephone Number	:	317-296-4187
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	02/01/2021

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Directions to “ BABE BLACK LCSW” Practice Location

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