MEDICARE: JAMES KEITH NEEDLER JR. LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	1880	KY

General Provider Information

NPI Number	:	1013021203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES KEITH NEEDLER JR. LCSW

Provider Business Mailing Address
First Line	:	527 CAMP ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40203-2634
Country	:	US
Telephone Number	:	502-637-6345
Fax Number	:

Provider Business Practice Location Address
First Line	:	3906 DUPONT SQ S
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4647
Country	:	US
Telephone Number	:	502-893-6654
Fax Number	:	502-893-0000

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2007

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