MEDICARE: MARTIN BECK CSW

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	258054	KY

General Provider Information

NPI Number	:	1457037608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN BECK CSW

Provider Business Mailing Address
First Line	:	4601 SHELBY LN
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40515-8533
Country	:	US
Telephone Number	:	646-831-2018
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 W SECOND ST STE 207
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40508-1268
Country	:	US
Telephone Number	:	646-831-2018
Fax Number	:

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

Provider Enumeration Date	:	06/23/2023
Last Update Date	:	06/23/2023

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Directions to “ MARTIN BECK CSW” Practice Location

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