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General NPI Number Information
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NPI Number | 1396003414
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Entity Type | Individual
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Provider Name | RYAN RUSSELL BLACK LMSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 04/26/2012
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | BRIAN D. ALLGOOD ARMY COMMUNITY HOSPITAL OPC 371 BOX 39
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City | APO
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State | AP
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Zip | 96271-9001
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Country | US
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Telephone | 315-737-3711
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Fax |
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Provider Business Mailing Address
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Address Line | BRIAN D. ALLGOOD ARMY COMMUNITY HOSPITAL OPC 371 BOX 39
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City | APO
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State | AP
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Zip | 96271
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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 |
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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 | C008913
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License Number State | NC
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