Sandra E Black, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1607-123 Issued in WI

Practice address

1317 W Grand Ave
Port Washington, WI 53074-2075

Phone

(262) 284-5789

Fax

(262) 284-5907

NPI assigned

May 27, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192665600000",
    "number": "1407803489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 W GRAND AVE",
            "city": "PORT WASHINGTON",
            "state": "WI",
            "postal_code": "530742075",
            "telephone_number": "262-284-5789",
            "fax_number": "262-284-5907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 W GRAND AVE",
            "city": "PORT WASHINGTON",
            "state": "WI",
            "postal_code": "530742075",
            "telephone_number": "262-284-5789",
            "fax_number": "262-284-5907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "SANDRA",
        "middle_name": "E",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-27",
        "last_updated": "2007-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "1607-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39730600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Martin T Becker, RPH
• Emily Belter, M.S.,CCC-SLP
• Breanne N Beres, DPT, ATC
• Mary Frances Bernadette, MOTR,/LOTR
• Best Self Counseling Center LLP
• Roger Blanchard, MSW, LCSW
• Cameron Blegen, M.D.
• Sara Bodenhamer, D.O.
• John P Bonavia, MD
• Jeffrey Joseph Bongiorno, DPM

• Clinical Social Worker in Port Washington, WI
• Providers in Port Washington, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2007; 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.