| Doctor Name: | LEORA ELIZABETH BLACK |
| NPI Number: | 1003986407 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 068-0000067 |
| Business Practice Address: | 245 S Park Dr Suite 2 Colchester, VT - 054465972 |
| Business Phone Number: | 8022645333 |
| Business Fax Number: | 8022645338 |
| Mailing Address: | 192 Depot Rd, COLCHESTER |
| State: | VT |
| Postal Code: | 054467668 |
| Phone Number: | 8022645333 |
| Fax Number: | 8022645338 |
| NPI Enumeration Date: | 11/09/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 068-0000067 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |