Healthcare Provider Details

I. General information

NPI: 1992914014
Provider Name (Legal Business Name): CATHOLIC CHARITIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3629 CHURCH ST
COVINGTON KY
41015-1430
US

IV. Provider business mailing address

3629 CHURCH ST
COVINGTON KY
41015-1430
US

V. Phone/Fax

Practice location:
  • Phone: 859-581-8974
  • Fax: 859-581-9595
Mailing address:
  • Phone: 859-581-8974
  • Fax: 859-581-9595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberKY-2076
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2066
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0930
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY H. MASSIE
Title or Position: CFO
Credential:
Phone: 859-581-8974