Healthcare Provider Details

I. General information

NPI: 1326067323
Provider Name (Legal Business Name): FAY C MCCUTCHAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 CRESTWOOD STA SUITE A
CRESTWOOD KY
40014-7418
US

IV. Provider business mailing address

3406 INDIAN LAKE DR
LOUISVILLE KY
40241-3406
US

V. Phone/Fax

Practice location:
  • Phone: 502-241-2909
  • Fax: 502-241-6811
Mailing address:
  • Phone: 502-290-7288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1986
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: