Healthcare Provider Details

I. General information

NPI: 1295800811
Provider Name (Legal Business Name): STACIE HOPE RUTAR MSW,CSW,LISW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACIE HOPE CAHILL

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 FARRELL DR
COVINGTON KY
41011-3775
US

IV. Provider business mailing address

503 FARRELL DR
COVINGTON KY
41011-3775
US

V. Phone/Fax

Practice location:
  • Phone: 859-331-3292
  • Fax: 859-578-2864
Mailing address:
  • Phone: 859-331-3292
  • Fax: 859-578-2864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3339
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: