MEDICARE: MRS. LORA ROBERTS REID MSW,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	104100000X	Social Worker	5413	KY
2	1041C0700X	Clinical Social Worker	252385	KY

General Provider Information

NPI Number	:	1699006023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORA ROBERTS REID MSW,CSW

Provider Business Mailing Address
First Line	:	496 SOUTHLAND DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1827
Country	:	US
Telephone Number	:	859-288-2392
Fax Number	:	859-721-3918

Provider Business Practice Location Address
First Line	:	1113 CENTRE PKWY
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-3208
Country	:	US
Telephone Number	:	859-288-2425
Fax Number	:	859-721-2572

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

Provider Enumeration Date	:	01/25/2010
Last Update Date	:	08/21/2020

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