MEDICARE: MS. CRYSTAL R MAYFIELD BSW, CADC, CSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0898	KY
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1235442013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CRYSTAL R MAYFIELD BSW, CADC, CSS

Provider Business Mailing Address
First Line	:	3107 CINCINNATI RD
Second Line	:
City	:	GEORGETOWN
State	:	KY
Zip	:	40324-9505
Country	:	US
Telephone Number	:	502-570-9313
Fax Number	:

Provider Business Practice Location Address
First Line	:	3107 CINCINNATI RD
Second Line	:
City	:	GEORGETOWN
State	:	KY
Zip	:	40324-9505
Country	:	US
Telephone Number	:	502-570-9313
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2010
Last Update Date	:	07/21/2010

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