Active NPI
Matthew James Black
- Clinical Social Worker
- South Salt Lake, UT
National Provider Identifier
1639941925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 11705657-3502
- Practice address
- 331 W 2700 S
South Salt Lake, UT 84115-2904 - Phone
- (801) 678-3317
- NPI assigned
- Oct 30, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 11705657-3502 | UT | Primary |
Addresses
Primary practice location
331 W 2700 S
South Salt Lake, UT 84115-2904
Mailing address
331 W 2700 S
South Salt Lake, UT 84115-2904
Phone (801) 678-3317
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11705657-3502 | UT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716940800000",
"number": "1639941925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "331 W 2700 S",
"city": "SOUTH SALT LAKE",
"state": "UT",
"postal_code": "841152904",
"telephone_number": "801-678-3317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "331 W 2700 S",
"city": "SOUTH SALT LAKE",
"state": "UT",
"postal_code": "841152904",
"telephone_number": "801-678-3317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "MATTHEW",
"middle_name": "JAMES",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-10-30",
"last_updated": "2024-05-29",
"certification_date": "2024-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "11705657-3502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Salt Lake, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.