Healthcare Provider Details

I. General information

NPI: 1619307709
Provider Name (Legal Business Name): BARBARA MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 GLENSBORO RD
LAWRENCEBURG KY
40342-9033
US

IV. Provider business mailing address

1060 GLENSBORO RD
LAWRENCEBURG KY
40342-9033
US

V. Phone/Fax

Practice location:
  • Phone: 502-839-7203
  • Fax: 502-839-0041
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2781
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: