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General NPI Number Information
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NPI Number | 1194541052
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Entity Type | Individual
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Provider Name | CINDY ANN BLACK LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 25 HOSPITAL DR
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City | BRIDGTON
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State | ME
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Zip | 04009-1167
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Country | US
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Telephone | 207-524-3501
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Fax | 207-647-4000
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Provider Business Mailing Address
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Address Line | 254 HUNTS CORNER RD
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City | WATERFORD
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State | ME
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Zip | 04088-3314
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Country | US
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Telephone | 781-405-1977
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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