Matthew James Black
Social Worker, Clinical in South Salt Lake, UT. Individual provider (NPI-1).
NPI number1639941925
StatusActive
Last updated in NPPESMay 29, 2024
Details
- NPI
- 1639941925
- Entity type
- Individual (NPI-1)
- Name
- Matthew James Black
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 30, 2023
- Certification date
- May 29, 2024
- Last updated
- May 29, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 11705657-3502 | UT | Yes |
Practice location
331 W 2700 SSouth Salt Lake, UT 84115-2904
Phone 801-678-3317
Mailing address
331 W 2700 SSouth Salt Lake, UT 84115-2904
Phone 801-678-3317
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