MEDICARE: MRS. MARY HENDY SEELBACH L.C.S.W.

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	0969	KY

General Provider Information

NPI Number	:	1235241761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY HENDY SEELBACH L.C.S.W.

Provider Business Mailing Address
First Line	:	312 CRILLON DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-2606
Country	:	US
Telephone Number	:	859-351-5166
Fax Number	:	859-278-0802

Provider Business Practice Location Address
First Line	:	1517 NICHOLASVILLE RD STE 302
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1429
Country	:	US
Telephone Number	:	859-351-5166
Fax Number	:	859-278-0802

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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