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NPI Code Detail

MEDICARE: MRS. MARY GRACE BLACK LCSW

MEDICARE: MRS. MARY GRACE 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
11041C0700XClinical Social Worker31MT

Other Identifiers

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

General Provider Information

NPI Number : 1790824050
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY GRACE BLACK LCSW
Provider Business Mailing Address
First Line : 48 MEDICAL PARK DR
Second Line :
City : HELENA
State : MT
Zip : 59601-4925
Country : US
Telephone Number : 406-449-3880
Fax Number : 406-442-6935
Provider Business Practice Location Address
First Line : 48 MEDICAL PARK DR
Second Line :
City : HELENA
State : MT
Zip : 59601-4925
Country : US
Telephone Number : 406-449-3880
Fax Number : 406-442-6935
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2007
Last Update Date : 07/08/2007

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