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MRS. MARIAN RUTH BLACK LCSW

Clinical >> Social Worker >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1902051360

Individual Registrant:
MRS. MARIAN RUTH BLACK LCSW
Gender: F
Sole Proprietor

Location and contact information for practice:
507 MECHEM DR  RUIDOSO, NM 88345-6902 US
Tel: 575-257-9217  Fax: 575-257-6989

Contact information for business:
223 RIO ST  RUIDOSO, NM 88345-7401 US
Tel: 575-937-2611  Fax: 575-257-6989

Registration Information:
NPI: 1902051360
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1041C0700XBehavioral Health & Social Service Providers
Social Worker
Clinical
TX40529

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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