Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103TF0000X | Family Psychologist |
NPI | 1053534222 |
---|---|
Provider Name | Dr. Danielle Anna Black |
First Address | Evanston, IL 60201-2908 |
Second Address | Evanston, IL 60201-2908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/07/2007 |