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NPI Code Detail

MEDICARE: STACY L MILES LCSW

MEDICARE: STACY L MILES 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 Worker1701KY

General Provider Information

NPI Number : 1326152646
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY L MILES LCSW
Provider Business Mailing Address
First Line : 101 W MUHAMMAD ALI BLVD
Second Line : HUMAN RESOURCES
City : LOUISVILLE
State : KY
Zip : 40202-1423
Country : US
Telephone Number : 502-589-1100
Fax Number : 502-589-8771
Provider Business Practice Location Address
First Line : 914 E BROADWAY
Second Line : SUITE 279
City : LOUISVILLE
State : KY
Zip : 40204-1037
Country : US
Telephone Number : 502-589-8600
Fax Number : 502-589-8771
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2006
Last Update Date : 07/08/2007

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Directions to “ STACY L MILES LCSW” Practice Location

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