Provider Demographics
NPI:1942323365
Name:BLACK, MERRILL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MERRILL
Middle Name:
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 1:10 COUNTY CENTER RD STE 133
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1533
Mailing Address - Country:US
Mailing Address - Phone:914-422-1511
Mailing Address - Fax:914-422-2511
Practice Address - Street 1:10 COUNTY CENTER RD STE 133
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1537
Practice Address - Country:US
Practice Address - Phone:914-422-1511
Practice Address - Fax:914-422-2511
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO36275-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical