Nicholas J. Black, LMSW
Individual provider Active NPI School Social Worker · Moriarty, NM
NPI 1184764698 · NPPES record last updated Sep 25, 2007
Key facts
- NPI
- 1184764698
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Social Worker 1041S0200X
- License
- M-04746 (NM)
- Practice address
- 350 McNabb Rd
Moriarty, NM 87035 - Phone
- (505) 638-5491
- Fax
- (505) 638-5571
- NPI assigned
- Feb 7, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M-04746 | NM | MD | School Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Social Worker | 1041S0200X | M-04746 | NM | Yes |
Addresses
Primary practice location
350 McNabb Rd
Moriarty, NM 87035
Mailing address
PO Box 1395
Moriarty, NM 87035-1395
Phone (505) 832-4529
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6281583 | Medicaid | NM |
Other providers in Moriarty, NM
- Linda Jo Banda
- Melody Michelle Benavidez
- Gabrielle Elizabeth Benitez
- Keirstin Bennett
- Kimberly A Birch
- Chantala Booth
- Kathleen Brown
- Shannon Marie Burke
- City of Moriarty
- Jennifer Como
All providers in Moriarty, NM · School Social Worker in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 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.