| Doctor Name: | MR. NICHOLAS J. BLACK |
| NPI Number: | 1184764698 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMSW |
| License Number: | M-04746 |
| Business Practice Address: | 350 Mcnabb Rd Moriarty, NM - 87035 |
| Business Phone Number: | 5056385491 |
| Business Fax Number: | 5056385571 |
| Mailing Address: | Po Box 1395, MORIARTY |
| State: | NM |
| Postal Code: | 870351395 |
| Phone Number: | 5058324529 |
| Fax Number: | |
| NPI Enumeration Date: | 02/07/2007 |
| NPI Last Update Date: | 09/25/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041S0200X |
| License Number: | M-04746 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |