Healthcare Provider Details

I. General information

NPI: 1568636793
Provider Name (Legal Business Name): CHARLOTTE A HUTSON CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1382 S 3RD ST
LOUISVILLE KY
40208-2351
US

IV. Provider business mailing address

1382 S 3RD ST
LOUISVILLE KY
40208-2351
US

V. Phone/Fax

Practice location:
  • Phone: 502-637-4361
  • Fax: 502-637-4490
Mailing address:
  • Phone: 502-637-4361
  • Fax: 502-637-4490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberKY-2292
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: