Healthcare Provider Details

I. General information

NPI: 1245195791
Provider Name (Legal Business Name): RHONDA L BLACK LICSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 MEDFORD ST
ARLINGTON MA
02474-3124
US

IV. Provider business mailing address

43 GLEASON RD
LEXINGTON MA
02420-3309
US

V. Phone/Fax

Practice location:
  • Phone: 781-863-9591
  • Fax:
Mailing address:
  • Phone: 781-863-9591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RHONDA LEE BLACK
Title or Position: OWNER
Credential: LICSW
Phone: 781-863-8591