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NPI Code Detail

MEDICARE: AMY THOMAS LISW, LCSW

MEDICARE:   AMY  THOMAS  LISW, 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
1104100000XSocial Worker

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1184607OTHERKYMEDICARE GROUP NUMBER

General Provider Information

NPI Number : 1164454898
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY THOMAS LISW, LCSW
Provider Business Mailing Address
First Line : 7000 HOUSTON RD
Second Line : SUITE 29
City : FLORENCE
State : KY
Zip : 41042-4873
Country : US
Telephone Number : 859-746-9272
Fax Number :
Provider Business Practice Location Address
First Line : 800 COMPTON RD UNIT 12
Second Line :
City : CINCINNATI
State : OH
Zip : 45231-3846
Country : US
Telephone Number : 859-746-9272
Fax Number : 513-521-3175
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2006
Last Update Date : 11/30/2017

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Directions to “ AMY THOMAS LISW, LCSW” Practice Location

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