Provider Demographics
NPI:1255497988
Name:BLACK, SUZANNE (MS, MSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:MS, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-6008
Mailing Address - Country:US
Mailing Address - Phone:401-421-0355
Mailing Address - Fax:401-475-1591
Practice Address - Street 1:100 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6008
Practice Address - Country:US
Practice Address - Phone:401-421-0355
Practice Address - Fax:401-475-1591
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCDP00189101YA0400X
RIISW002551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical