Healthcare Provider Details

I. General information

NPI: 1851548572
Provider Name (Legal Business Name): HILARY MARY BLACK MSW INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 SANDERSON ST
GREENFIELD MA
01301-2715
US

IV. Provider business mailing address

1089 MOHAWK TRL
SHELBURNE FALLS MA
01370-9784
US

V. Phone/Fax

Practice location:
  • Phone: 413-773-2744
  • Fax:
Mailing address:
  • Phone: 413-222-3361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: