Jerrilyn Black, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LC50081921 Issued in DC

Practice address

6645 Georgia Ave NW Apt 201
Washington, DC 20012-2539

Phone

(817) 205-1283

NPI assigned

Jun 9, 2019

Last updated

Jan 19, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• J. Francis Black LLC

  • Community/Behavioral Health Agency
  • Washington, DC
  • NPI 1043851868
  NPD (past) Authorized official

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

{
    "created_epoch": "1560038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579392000000",
    "number": "1831758374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 CONNECTICUT AVE NW STE 137",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200082549",
            "telephone_number": "202-643-1501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6645 GEORGIA AVE NW APT 201",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200122539",
            "telephone_number": "817-205-1283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "JERRILYN",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-09",
        "last_updated": "2020-01-19",
        "certification_date": "2020-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "DC",
            "license": "LC50081921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@jerrilynblack.com",
            "affiliation": "N",
            "address_1": "3000 Connecticut Ave NW Ste 137",
            "city": "Washington",
            "state": "DC",
            "country_code": "US",
            "postal_code": "200082549",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Derquacia Black
• Elena Black
• Elijah Taylor Black
• Hannah Black
• Janice Black
• Joy Black
• Monique L Black
• Myesa Harris Black
• Nancy Burgess Black, M.D.
• Oprah Mari Charran Black

• Clinical Social Worker in Washington, DC
• Providers in Washington, DC by specialty
• Clinical Social Worker in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2020; 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.