Provider Demographics
NPI:1255978573
Name:BLACK, SALEM CALEB (LICSW)
Entity type:Individual
Prefix:
First Name:SALEM
Middle Name:CALEB
Last Name:BLACK
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 LONGWOOD AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:383 ELLIOT ST STE 100
Practice Address - Street 2:
Practice Address - City:NEWTON UPPER FALLS
Practice Address - State:MA
Practice Address - Zip Code:02464-1126
Practice Address - Country:US
Practice Address - Phone:888-695-7775
Practice Address - Fax:888-695-7775
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2254181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical