Provider Demographics
NPI:1194907113
Name:HUBERT-BLACK, CAROLYN (LMT/DOULA)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:HUBERT-BLACK
Suffix:
Gender:F
Credentials:LMT/DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 GEIGER RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1030
Mailing Address - Country:US
Mailing Address - Phone:267-864-8639
Mailing Address - Fax:
Practice Address - Street 1:220 GEIGER RD
Practice Address - Street 2:SUITE 203
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1030
Practice Address - Country:US
Practice Address - Phone:267-864-8639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2015-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMASSAGE THERAPIST175L00000X
374J00000X
PAMSG4609225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No175L00000XOther Service ProvidersHomeopath
No374J00000XNursing Service Related ProvidersDoula