MEDICARE: TAMARA KAY HUBBARD 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	KY-1940	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12385425	OTHER	KY	CAQH
2	KY-1940	OTHER	KY	STATE LICENSE

General Provider Information

NPI Number	:	1619129681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA KAY HUBBARD LCSW

Provider Business Mailing Address
First Line	:	6452 W HIGHWAY 146
Second Line	:
City	:	CRESTWOOD
State	:	KY
Zip	:	40014-9575
Country	:	US
Telephone Number	:	502-338-3653
Fax Number	:	502-540-3070

Provider Business Practice Location Address
First Line	:	6452 W HIGHWAY 146
Second Line	:
City	:	CRESTWOOD
State	:	KY
Zip	:	40014-9575
Country	:	US
Telephone Number	:	23-383-6535
Fax Number	:

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	06/19/2023

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