Healthcare Provider Details

I. General information

NPI: 1124368741
Provider Name (Legal Business Name): AMY S SUTTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 LAWRENCEBURG FERRY RD
PETERSBURG KY
41080-8702
US

IV. Provider business mailing address

2440 LAWRENCEBURG FERRY RD
PETERSBURG KY
41080-8702
US

V. Phone/Fax

Practice location:
  • Phone: 859-445-3556
  • Fax: 502-567-5620
Mailing address:
  • Phone: 859-445-3556
  • Fax: 502-567-5620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3257
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: