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General NPI Number Information
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NPI Number | 1225628811
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Entity Type | Organization
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Legal Business Name | BLACK BROOK COUNSELING PLLC
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Dates
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Enumeration Date | 01/19/2021
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Last Update Date | 01/19/2021
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Provider Practice Location Address
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Address Line | 4 SHORELINE DR UNIT 6
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City | BOSCAWEN
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State | NH
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Zip | 03303-3523
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Country | US
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Telephone | 781-789-5359
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Fax |
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Provider Business Mailing Address
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Address Line | 4 SHORELINE DR UNIT 6
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City | BOSCAWEN
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State | NH
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Zip | 03303-3523
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACQUELINE KARAS
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Credential | LICSW
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Telephone | 781-789-5359
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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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