Provider Demographics
NPI:1043904089
Name:BLACK, ANNABELLE (BCABA)
Entity type:Individual
Prefix:
First Name:ANNABELLE
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 PORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NH
Mailing Address - Zip Code:03584-3347
Mailing Address - Country:US
Mailing Address - Phone:603-991-2267
Mailing Address - Fax:
Practice Address - Street 1:397 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:SAINT JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-1739
Practice Address - Country:US
Practice Address - Phone:802-424-1042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst