Active NPI
Agnes Black, LCSW
- Clinical Social Worker
- Hartford, CT
National Provider Identifier
1730332487
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 231744423
- Practice address
- 500 Vine St
Capitol Region Mental Health Center
Hartford, CT 06114 - Phone
- (860) 297-0905
- Fax
- (860) 297-0931
- NPI assigned
- Oct 28, 2008
- Sex
- Female
- 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 | 231744423 | CT | Primary |
Addresses
Primary practice location
500 Vine St
Capitol Region Mental Health Center
Hartford, CT 06114
Mailing address
500 Vine Street
Human Resource
Hartford, CT 06114
Phone (860) 297-0905
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 |
|---|---|---|---|
| 231744423 | CT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225152000000",
"number": "1730332487",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 VINE STREET",
"address_2": "HUMAN RESOURCE",
"city": "HARTFORD",
"state": "CT",
"postal_code": "06114",
"telephone_number": "860-297-0905",
"fax_number": "860-297-0931"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 VINE ST",
"address_2": "CAPITOL REGION MENTAL HEALTH CENTER",
"city": "HARTFORD",
"state": "CT",
"postal_code": "06114",
"telephone_number": "860-297-0905",
"fax_number": "860-297-0931"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "AGNES",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-28",
"last_updated": "2008-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "231744423",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hartford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.