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General NPI Number Information
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NPI Number | 1437168044
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Entity Type | Organization
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Legal Business Name | BRUCE BLACK M.D. P.C.
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 372 WASHINGTON ST
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City | WELLESLEY
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State | MA
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Zip | 02481-6202
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Country | US
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Telephone | 781-239-3550
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Fax | 781-239-3272
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Provider Business Mailing Address
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Address Line | 372 WASHINGTON ST
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City | WELLESLEY
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State | MA
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Zip | 02481-6202
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Country | US
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Telephone | 781-239-3550
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Fax | 781-239-3272
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | ROBIN BALLARD
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Credential |
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Telephone | 781-239-3550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State | MA
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Taxonomy #2
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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 | MA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State | MA
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Taxonomy #5
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State | MA
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