Provider Demographics
NPI:1659317444
Name:BLACK, SYLVIA JOY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:JOY
Last Name:BLACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 N CADDO ST
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76031-4904
Mailing Address - Country:US
Mailing Address - Phone:817-558-2988
Mailing Address - Fax:817-558-3157
Practice Address - Street 1:214 N CADDO ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76031-4904
Practice Address - Country:US
Practice Address - Phone:817-558-2988
Practice Address - Fax:817-558-3157
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS143901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S46SMedicare ID - Type Unspecified