MEDICARE: MR. HENRY FERRIS AUSTIN LCSW

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	1041C0700X	Clinical Social Worker	0639	KY

General Provider Information

NPI Number	:	1881694610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HENRY FERRIS AUSTIN LCSW

Provider Business Mailing Address
First Line	:	4010 DUPONT CIR
Second Line	:	SUITE 562
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4812
Country	:	US
Telephone Number	:	502-896-1850
Fax Number	:	502-896-6863

Provider Business Practice Location Address
First Line	:	4010 DUPONT CIR
Second Line	:	SUITE 562
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4812
Country	:	US
Telephone Number	:	502-896-1850
Fax Number	:	502-896-6863

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	10/07/2011

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