Healthcare Provider Details

I. General information

NPI: 1710440441
Provider Name (Legal Business Name): BRITTA D CAUDILL DSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 FRASURE HILL DR
PRESTONSBURG KY
41653-8910
US

IV. Provider business mailing address

140 FRASURE HILL DR
PRESTONSBURG KY
41653-8910
US

V. Phone/Fax

Practice location:
  • Phone: 606-506-4291
  • Fax: 606-506-0147
Mailing address:
  • Phone: 606-506-4291
  • Fax: 606-506-0147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number253998
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: