Healthcare Provider Details

I. General information

NPI: 1003246422
Provider Name (Legal Business Name): MCKENZIE DANIELLE LINTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2013
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 BLOOMFIELD RD
BARDSTOWN KY
40004-9708
US

IV. Provider business mailing address

353 WESTERN DR
RADCLIFF KY
40160-2087
US

V. Phone/Fax

Practice location:
  • Phone: 502-509-6717
  • Fax:
Mailing address:
  • Phone: 614-620-7773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3774
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: