Healthcare Provider Details

I. General information

NPI: 1518126556
Provider Name (Legal Business Name): ROBERTA HART SEWELL MS, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 BARRET AVE
LOUISVILLE KY
40204-1667
US

IV. Provider business mailing address

1028 BARRET AVE
LOUISVILLE KY
40204-1667
US

V. Phone/Fax

Practice location:
  • Phone: 502-451-1221
  • Fax: 502-451-1334
Mailing address:
  • Phone: 502-451-1221
  • Fax: 502-451-1334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberKY-0173
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: