Healthcare Provider Details

I. General information

NPI: 1528585478
Provider Name (Legal Business Name): CHRIS J PABLO DSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 LEESTOWN RD
LEXINGTON KY
40511-1052
US

IV. Provider business mailing address

2250 LEESTOWN RD
LEXINGTON KY
40511-1052
US

V. Phone/Fax

Practice location:
  • Phone: 859-233-4511
  • Fax: 859-281-3823
Mailing address:
  • Phone: 859-233-4511
  • Fax: 859-281-3823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number255655
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: