Most Relevant Information
Provider Data
| NPI Number: | 1003518028 |
| Provider Name: | ALEXANDER JERROD BLACK ACSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 114171 |
Most Important Dates
| Enumeration Date: | 03/21/2023 |
| Last Updated: | 03/21/2023 |
Provider Practice Location
611 S KINGSLEY DR
LOS ANGELES
CA
900052319
Practice Location Phone/Fax
| Phone: | 2132011600 |
| Fax: |
Provider Mailing Location
4047 HALLDALE AVE
LOS ANGELES
CA
900621851
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |