Active NPI
Mary Grace Black, LCSW
- Clinical Social Worker
- Helena, MT
National Provider Identifier
1790824050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 31
- Practice address
- 48 Medical Park Dr
Helena, MT 59601-4925 - Phone
- (406) 449-3880
- Fax
- (406) 442-6935
- NPI assigned
- Feb 5, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 31 | MT | Primary |
Addresses
Primary practice location
48 Medical Park Dr
Helena, MT 59601-4925
Mailing address
48 Medical Park Dr
Helena, MT 59601-4925
Phone (406) 449-3880
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0500357 | Medicaid | MT |
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 |
|---|---|---|---|
| 31 | MT | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790824050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "48 MEDICAL PARK DR",
"city": "HELENA",
"state": "MT",
"postal_code": "596014925",
"telephone_number": "406-449-3880",
"fax_number": "406-442-6935"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "48 MEDICAL PARK DR",
"city": "HELENA",
"state": "MT",
"postal_code": "596014925",
"telephone_number": "406-449-3880",
"fax_number": "406-442-6935"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "MARY GRACE",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MT",
"license": "31",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0500357",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Helena, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.