Provider Demographics
NPI:1447527726
Name:BLACK, KYTRA (LCSW)
Entity type:Individual
Prefix:MS
First Name:KYTRA
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 BROADWAY
Mailing Address - Street 2:4TH FLOOR - SPARK PROGRAM/HOSPICE & PALLIATIVE CARE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3701
Mailing Address - Country:US
Mailing Address - Phone:212-630-5290
Mailing Address - Fax:212-290-0158
Practice Address - Street 1:1250 BROADWAY
Practice Address - Street 2:4TH FLOOR - SPARK PROGRAM/HOSPICE & PALLIATIVE CARE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3701
Practice Address - Country:US
Practice Address - Phone:212-630-5290
Practice Address - Fax:212-290-0158
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077861-11041C0700X
FLSW97131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical