MEDICARE: CASSANDRA L 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	1041C0700X	Clinical Social Worker	20650	CA

General Provider Information

NPI Number	:	1629257373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA L BLACK

Provider Business Mailing Address
First Line	:	2880 HULEN PL
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-2606
Country	:	US
Telephone Number	:	951-595-4444
Fax Number	:

Provider Business Practice Location Address
First Line	:	2880 HULEN PL
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-2606
Country	:	US
Telephone Number	:	951-595-4444
Fax Number	:

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

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	03/04/2019

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Directions to “ CASSANDRA L BLACK ” Practice Location

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