Stephanie Broadbent Black, LCSW, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

008091 Issued in IA

Practice address

2319 Catskill CT
Iowa City, IA 52245-5250

Phone

(319) 621-9581

NPI assigned

Aug 14, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Stephanie Patrice Black Other name

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": "1187049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380758400000",
    "number": "1477745446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "533 N 450 E",
            "city": "SPRINGVILLE",
            "state": "UT",
            "postal_code": "846633402",
            "telephone_number": "319-621-9581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2319 CATSKILL CT",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522455250",
            "telephone_number": "319-621-9581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "STEPHANIE",
        "middle_name": "BROADBENT",
        "credential": "LCSW, LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-14",
        "last_updated": "2013-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "6656502-3502",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "6656502-3501",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "008091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "BLACK",
            "middle_name": "PATRICE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Lilja T Bjornsdottir, M.D.
• Katherine D Bjornsen, ARNP
• Black & Gold Chiropractic & Wellness LLC
• Andrea Lee Black, RN
• Donald W Black, MD
• Shayla Marie Blackburn, LPN
• Jared Nicholas Blad, MD
• Adam Russell Blaine, MD
• Nathan Michael Blair, M.D.
• Robert Alvin Blair, D.D.S.

• Clinical Social Worker in Iowa City, IA
• Providers in Iowa City, IA by specialty
• Clinical Social Worker in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2013; 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.