MEDICARE: JOHN NERSWICK PH.D., LMFT

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	106H00000X	Marriage & Family Therapist	MFTMFT00213907	KY

General Provider Information

NPI Number	:	1912337528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN NERSWICK PH.D., LMFT

Provider Business Mailing Address
First Line	:	2861 BLUEGRASS DR
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	KY
Zip	:	41076
Country	:	US
Telephone Number	:	859-442-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2861 BLUEGRASS DR
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	KY
Zip	:	41076
Country	:	US
Telephone Number	:	859-442-8500
Fax Number	:

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

Provider Enumeration Date	:	11/18/2013
Last Update Date	:	11/20/2014

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