Provider Demographics
NPI:1831235183
Name:BLACK, CLAIRE ELIZABETH (MS)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:ELIZABETH
Last Name:BLACK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:ELIZABETH
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-4432
Mailing Address - Country:US
Mailing Address - Phone:717-243-6033
Mailing Address - Fax:717-243-0776
Practice Address - Street 1:33 STATE AVE
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-4432
Practice Address - Country:US
Practice Address - Phone:717-243-6033
Practice Address - Fax:717-243-0776
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007540L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist