| Dan Black Enterprises Inc | |
|
6030 Nw 42nd Ave Coconut Creek FL 33073-3272 | |
| (954) 290-9282 | |
| (561) 853-2195 |
| Full Name | Dan Black Enterprises Inc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 6030 Nw 42nd Ave, Coconut Creek, Florida |
| Authorized Official Name and Position | Daniel Spencer Black (PRESIDENT) |
| Authorized Official Contact | 9542909282 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dan Black Enterprises Inc 6030 Nw 42nd Ave Coconut Creek FL 33073-3272 Ph: (954) 290-9282 | Dan Black Enterprises Inc 6030 Nw 42nd Ave Coconut Creek FL 33073-3272 Ph: (954) 290-9282 |
| NPI Number | 1104116870 |
|---|---|
| Provider Enumeration Date | 04/14/2011 |
| Last Update Date | 06/02/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104116870 | NPI | - | NPPES |
| 676044996 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 0833 (Florida) | Primary |
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