Ellis Luca Black, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD60937058 Issued in WA

Practice address

2711 E Madison St Ste 204
Seattle, WA 98112-4763

Phone

(206) 984-3924

Fax

(206) 339-1776

NPI assigned

May 11, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Dr. Laura Elizabeth Black Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1013395904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2711 E MADISON ST STE 204",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981124763",
            "telephone_number": "206-984-3924",
            "fax_number": "206-339-1776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2711 E MADISON ST STE 204",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981124763",
            "telephone_number": "206-984-3924",
            "fax_number": "206-339-1776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "ELLIS",
        "middle_name": "LUCA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-11",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "WA",
            "license": "MD60937058",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "MD60937058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "BLACK",
            "middle_name": "ELIZABETH",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Brian Black, PTA
• Charlotte Black, CCC-SLP
• Christina Black, PA-C
• Cindy Meredith Black, BA
• Eliza Black, PA-C
• Erica Lynn Black, LMP
• Erin Mary Black, LMP
• Hayden Black, DDS
• Joleen Denise Black, LMT
• Joseph Andrew Black, CPC

• Psychiatry Physician in Seattle, WA
• Providers in Seattle, WA by specialty
• Psychiatry Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.