Black, Antoinette Marino
Black, Antoinette Marino is an sole proprietor health care provider with primary practice located at 9165 Otis Ave Ste 103 , Indianapolis IN 46216-2307. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Black, Antoinette Marino can be contacted via phone (317) 847-5697.Contact Information
Primary practice address
9165 Otis Ave Ste 103
Indianapolis IN 46216-2307
Phone: (317) 847-5697
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | 35001409A | Indiana |
Profile Details
| NPI number | 1518922038 |
|---|---|
| LBN Legal business name | Black, Antoinette Marino |
| Credentials | LMFT |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 18th, 2006 |
| Last updated | Apr 20th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1518922038 | NPPES |
| Indiana | MEDICAID | 100270530 |
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