MEDICARE: MARIKO CHINYANG KEMBLE 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	260343	KY

General Provider Information

NPI Number	:	1356234157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIKO CHINYANG KEMBLE LCSW

Provider Business Mailing Address
First Line	:	212 N 2ND ST STE 100
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-1408
Country	:	US
Telephone Number	:	502-777-1395
Fax Number	:

Provider Business Practice Location Address
First Line	:	4229 BARDSTOWN RD STE 310
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-3266
Country	:	US
Telephone Number	:	502-416-1416
Fax Number	:

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

Provider Enumeration Date	:	05/30/2025
Last Update Date	:	05/29/2026

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