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General NPI Number Information
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NPI Number | 1467328641
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Entity Type | Individual
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Provider Name | SYDNIE BLACK
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Gender | Female
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Dates
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Enumeration Date | 10/14/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 2441 CONSTITUTION DR
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City | LIVERMORE
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State | CA
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Zip | 94551-7573
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Country | US
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Telephone | 925-505-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 510 17TH ST
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City | OAKLAND
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State | CA
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Zip | 94612-1553
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Country | US
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Telephone | 510-433-1150
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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 | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number | 80390
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License Number State | CA
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