Healthcare Provider Details

I. General information

NPI: 1093181729
Provider Name (Legal Business Name): HOLLY BENDER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 NEWTOWN PIKE
LEXINGTON KY
40511-1275
US

IV. Provider business mailing address

1351 NEWTOWN PIKE
LEXINGTON KY
40511-1275
US

V. Phone/Fax

Practice location:
  • Phone: 859-233-0444
  • Fax:
Mailing address:
  • Phone: 859-233-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1101
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: