Healthcare Provider Details

I. General information

NPI: 1619900784
Provider Name (Legal Business Name): MARY D HUHN LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 FAIRFIELD AVE 2ND FLOOR
BELLEVUE KY
41073
US

IV. Provider business mailing address

227 FAIRFIELD AVE 2ND FLOOR
BELLEVUE KY
41073
US

V. Phone/Fax

Practice location:
  • Phone: 859-261-8483
  • Fax: 859-261-8483
Mailing address:
  • Phone: 859-261-8483
  • Fax: 859-261-8483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI5088
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0816
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: