Provider Demographics
NPI:1497065668
Name:BLACK, CHIQUITA (BS)
Entity Type:Individual
Prefix:
First Name:CHIQUITA
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 NW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DANIA
Mailing Address - State:FL
Mailing Address - Zip Code:33004-2710
Mailing Address - Country:US
Mailing Address - Phone:786-295-1815
Mailing Address - Fax:
Practice Address - Street 1:3500 N STATE ROAD 7 STE 211
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5625
Practice Address - Country:US
Practice Address - Phone:954-578-8399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker