Provider Demographics
NPI:1699862201
Name:BLACK, CAROL B (MS)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:B
Last Name:BLACK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 1/2 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST VIEW
Mailing Address - State:PA
Mailing Address - Zip Code:15229-1636
Mailing Address - Country:US
Mailing Address - Phone:412-931-9290
Mailing Address - Fax:412-931-4413
Practice Address - Street 1:1100 1/2 CENTER AVE
Practice Address - Street 2:
Practice Address - City:WEST VIEW
Practice Address - State:PA
Practice Address - Zip Code:15229-1636
Practice Address - Country:US
Practice Address - Phone:412-931-9290
Practice Address - Fax:412-931-4413
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000256L237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11226988OtherCAQH
PA501421OtherAETNA
PA004972486221OtherUNITED HEALTHCARE
PA11226988OtherCAQH