Provider Demographics
NPI:1225628811
Name:BLACK BROOK COUNSELING PLLC
Entity Type:Organization
Organization Name:BLACK BROOK COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:781-789-5359
Mailing Address - Street 1:4 SHORELINE DR UNIT 6
Mailing Address - Street 2:
Mailing Address - City:BOSCAWEN
Mailing Address - State:NH
Mailing Address - Zip Code:03303-3523
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 SHORELINE DR UNIT 6
Practice Address - Street 2:
Practice Address - City:BOSCAWEN
Practice Address - State:NH
Practice Address - Zip Code:03303-3523
Practice Address - Country:US
Practice Address - Phone:781-789-5359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1255716015OtherNPI 1