Michael S Black PH D and Park Psychological Services LTD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071-000739 Issued in IL

Legal business name

MICHAEL S BLACK PH D AND PARK PSYCHOLOGICAL SERVICES LTD

Practice address

473 Park Ave
Glencoe, IL 60022-1549

Phone

(847) 835-5517

Fax

(847) 835-3321

NPI assigned

Feb 16, 2009

Last updated

Feb 16, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Michael Stuart Black, PH.D.

Title

President

Phone

(847) 835-5517

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1234742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234742400000",
    "number": "1407095466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "473 PARK AVE",
            "city": "GLENCOE",
            "state": "IL",
            "postal_code": "600221549",
            "telephone_number": "947-835-5517",
            "fax_number": "847-835-3321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "473 PARK AVE",
            "city": "GLENCOE",
            "state": "IL",
            "postal_code": "600221549",
            "telephone_number": "847-835-5517",
            "fax_number": "847-835-3321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL S BLACK PH D AND PARK PSYCHOLOGICAL SERVICES LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-16",
        "last_updated": "2009-02-16",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "STUART",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-835-5517",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071-000739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathi Marks, SPY.D
• Robert R. Marsh, M.S.W., L.C.S.W
• Alice McKeever
• Melampus, LTD
• Joan Merlo, LCSW, MSW
• Julie M Milne, PH.D., LCPC
• Mindful Relationships and Parenting PLLC
• Miriam Fishman, Psy.D., LLC
• Eric Montes, LMT
• Emily Honora Mysel, LCSW

• Clinical Psychologist in Glencoe, IL
• Providers in Glencoe, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2009; 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.