| Doctor Name: | SUSAN L BLACK |
| NPI Number: | 1568430528 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW |
| License Number: | 5364 |
| Business Practice Address: | 238 Brookley Ave 11th Medical Group/sgoh Bolling Afb, DC - 20032 |
| Business Phone Number: | 2024044242 |
| Business Fax Number: | 2024047366 |
| Mailing Address: | 5007 Edenvale Ct, WALDORF |
| State: | MD |
| Postal Code: | 206023189 |
| Phone Number: | 2024044242 |
| Fax Number: | 2024047366 |
| NPI Enumeration Date: | 03/08/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 5364 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | SC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |