Provider Demographics
NPI:1003081365
Name:BLACK, BUCK J (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:BUCK
Middle Name:J
Last Name:BLACK
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SAW MILL RD
Mailing Address - Street 2:STE 3102
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-5592
Mailing Address - Country:US
Mailing Address - Phone:765-807-6778
Mailing Address - Fax:765-807-6778
Practice Address - Street 1:100 SAW MILL RD
Practice Address - Street 2:STE 3102
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5592
Practice Address - Country:US
Practice Address - Phone:765-807-6778
Practice Address - Fax:765-807-6778
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33005111A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker