Healthcare Provider Details

I. General information

NPI: 1558701003
Provider Name (Legal Business Name): CHRISTINA CLARE BLACK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 CHESTNUT AVE
DU BOIS PA
15801-2988
US

IV. Provider business mailing address

1324 CHESTNUT AVE
DU BOIS PA
15801-2988
US

V. Phone/Fax

Practice location:
  • Phone: 814-371-1088
  • Fax:
Mailing address:
  • Phone: 814-371-1088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW027511
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: