| NPI | 1124564679 |
|---|---|
| Former Name | ELIZABETH ROSE BLACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 26128) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2020-09-01 |