Provider Demographics
NPI:1366523870
Name:BLACK, IRWIN MICHAEL (LCSWR 041213 NYS)
Entity type:Individual
Prefix:MR
First Name:IRWIN
Middle Name:MICHAEL
Last Name:BLACK
Suffix:
Gender:M
Credentials:LCSWR 041213 NYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PELHAM BAY COUNSELING
Mailing Address - Street 2:44 WESTCHESTER SQUARE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461
Mailing Address - Country:US
Mailing Address - Phone:718-409-1047
Mailing Address - Fax:718-798-5204
Practice Address - Street 1:PELHAM BAY COUNSELING
Practice Address - Street 2:44 WESTCHESTER SQUARE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-409-1047
Practice Address - Fax:718-798-5204
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSWR 0412131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical