Provider Demographics
NPI:1730141441
Name:BLACK, MARGARET PROSSER (LCSW)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:PROSSER
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 1:8355 ROCKVILLE RD 120
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-2722
Mailing Address - Country:US
Mailing Address - Phone:317-908-1678
Mailing Address - Fax:
Practice Address - Street 1:13050 PARKSIDE DR
Practice Address - Street 2:SUITE 240
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-8247
Practice Address - Country:US
Practice Address - Phone:317-621-1100
Practice Address - Fax:317-621-1000
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005080A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical