MEDICARE: CADEEJHA BLACK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1043994411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CADEEJHA BLACK

Provider Business Mailing Address
First Line	:	6511 ELMHURST ST
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-2228
Country	:	US
Telephone Number	:	240-526-4416
Fax Number	:

Provider Business Practice Location Address
First Line	:	6511 ELMHURST ST
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-2228
Country	:	US
Telephone Number	:	240-526-4416
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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Directions to “ CADEEJHA BLACK ” Practice Location

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