MEDICARE: JENNIFER LYNE FADEL 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	7214	KY
2	1041C0700X	Clinical Social Worker	252898	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922491828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNE FADEL LCSW

Provider Business Mailing Address
First Line	:	346 S MAIN ST
Second Line	:
City	:	LEITCHFIELD
State	:	KY
Zip	:	42754-1428
Country	:	US
Telephone Number	:	270-230-1777
Fax Number	:	270-679-0838

Provider Business Practice Location Address
First Line	:	346 S MAIN ST
Second Line	:
City	:	LEITCHFIELD
State	:	KY
Zip	:	42754-1428
Country	:	US
Telephone Number	:	270-230-1777
Fax Number	:	270-679-0838

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

Provider Enumeration Date	:	03/17/2015
Last Update Date	:	04/08/2026

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