Healthcare Provider Details

I. General information

NPI: 1619832623
Provider Name (Legal Business Name): CARRIE JEANNE BLACK ASSOC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE HOWE ASSOC.

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 WOODMAN DR
DAYTON OH
45432-3439
US

IV. Provider business mailing address

700 DENNISON AVE
DAYTON OH
45417-3221
US

V. Phone/Fax

Practice location:
  • Phone: 513-470-1001
  • Fax:
Mailing address:
  • Phone: 513-787-4890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2084P0804X
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: