MEDICARE: ALISA R BIVENS 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	1041C0700X	Clinical Social Worker	LC145558	ME

General Provider Information

NPI Number	:	1104193929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISA R BIVENS LCSW

Provider Business Mailing Address
First Line	:	1501 ALEXANDRIA PIKE STE 102
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-2561
Country	:	US
Telephone Number	:	207-400-7758
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 ALEXANDRIA PIKE STE 102
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-2561
Country	:	US
Telephone Number	:	207-400-7758
Fax Number	:

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

Provider Enumeration Date	:	11/22/2011
Last Update Date	:	08/08/2023

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