Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TA0700X | Adult Development & Aging Psychologist | 020429 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 020429 | NY |
Y | 103G00000X | Clinical Psychologist | 020429 | NY |
Y | 103TC0700X | Clinical Psychologist | 020429 | NY |
N | 103TF0000X | Family Psychologist | 020429 | NY |
N | 103TH0004X | Health Psychologist | ||
N | 103TP2701X | Group Psychotherapist | 020429 | NY |
N | 103TR0400X | Rehabilitation Psychologist | 020429 | NY |
NPI | 1447776323 |
---|---|
Provider Name | Suzanne Alexandra Black |
First Address | New York, NY 10025-3452 |
Second Address | New York, NY 10025-3452 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2017 |
Last Update Date | 22/08/2017 |