Healthcare Provider Details

I. General information

NPI: 1033769971
Provider Name (Legal Business Name): MOLLY BENNETT PSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 LAWRENCEBURG RD
FRANKFORT KY
40601-9128
US

IV. Provider business mailing address

2225 LAWRENCEBURG RD
FRANKFORT KY
40601-9128
US

V. Phone/Fax

Practice location:
  • Phone: 502-351-2042
  • Fax: 502-480-4157
Mailing address:
  • Phone: 502-351-2042
  • Fax: 502-480-4157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number289489
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: