Healthcare Provider Details

I. General information

NPI: 1437118130
Provider Name (Legal Business Name): MARY RYAN HOSEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 10/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 BRECKENRIDGE LN SUITE 114
LOUISVILLE KY
40207-3868
US

IV. Provider business mailing address

214 BRECKENRIDGE LN SUITE 114
LOUISVILLE KY
40207-3868
US

V. Phone/Fax

Practice location:
  • Phone: 502-609-0197
  • Fax: 502-327-7705
Mailing address:
  • Phone: 502-609-0197
  • Fax: 502-327-7705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1002
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: