Devera Black, MSW LCSW
Individual provider Active NPI Clinical Social Worker · So Salem, NY
NPI 1043355233 · NPPES record last updated Jul 26, 2007
Key facts
- NPI
- 1043355233
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Practice address
- 71 Twin Lakes Rd
So Salem, NY 10590 - Phone
- (914) 763-3438
- NPI assigned
- Feb 21, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | NY | Yes |
Addresses
Primary practice location
71 Twin Lakes Rd
So Salem, NY 10590
Mailing address
71 Twin Lakes Rd
So Salem, NY 10590
Phone (914) 763-3438
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 26, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.