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General NPI Number Information
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NPI Number | 1164263976
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Entity Type | Individual
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Provider Name | ALEIA DVORAK CSW
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Gender | Female
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 1100 S 3RD ST
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City | LOUISVILLE
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State | KY
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Zip | 40203-2902
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Country | US
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Telephone | 502-822-6286
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Fax | 502-586-7147
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Provider Business Mailing Address
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Address Line | 1400 MAIN ST UNIT 172
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City | CLARKSVILLE
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State | IN
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Zip | 47129-3108
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Country | US
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Telephone | 502-654-8255
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 259163
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License Number State | KY
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