MEDICARE: JESSICA ELIZABETH DUVAL LCSW, LCADC

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	164426	KY
2	1041C0700X	Clinical Social Worker	254546	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295236537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ELIZABETH DUVAL LCSW, LCADC

Provider Business Mailing Address
First Line	:	1718 ALEXANDRIA DR STE 225
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3144
Country	:	US
Telephone Number	:	859-619-4591
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	:	02/22/2018
Last Update Date	:	11/09/2020

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