Healthcare Provider Details

I. General information

NPI: 1689807406
Provider Name (Legal Business Name): CHRISTINE E NICOLOSI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 07/30/2023
Certification Date: 07/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 ABBEY RD
VERSAILLES KY
40383-8063
US

IV. Provider business mailing address

269 ABBEY RD
VERSAILLES KY
40383-8063
US

V. Phone/Fax

Practice location:
  • Phone: 502-680-1932
  • Fax:
Mailing address:
  • Phone: 502-680-1932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number257815
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: