Healthcare Provider Details

I. General information

NPI: 1437250602
Provider Name (Legal Business Name): MABLE ROWE LINEBERGER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E COLLEGE ST #1
GEORGETOWN KY
40324-1603
US

IV. Provider business mailing address

101 E COLLEGE ST #1
GEORGETOWN KY
40324-1603
US

V. Phone/Fax

Practice location:
  • Phone: 502-570-8400
  • Fax: 502-570-9221
Mailing address:
  • Phone: 502-570-8400
  • Fax: 502-570-9221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number0822
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number0822
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0822
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0822
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0822
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: