Healthcare Provider Details

I. General information

NPI: 1871410118
Provider Name (Legal Business Name): MICHELLE RADER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 BURLINGTON PIKE STE 218
FLORENCE KY
41042-4910
US

IV. Provider business mailing address

4974 PETERSBURG RD
PETERSBURG KY
41080-9346
US

V. Phone/Fax

Practice location:
  • Phone: 859-445-6300
  • Fax:
Mailing address:
  • Phone: 859-445-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW00001611
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: