Provider Demographics
NPI:1013021203
Name:NEEDLER, JAMES KEITH JR (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KEITH
Last Name:NEEDLER
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 CAMP ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2634
Mailing Address - Country:US
Mailing Address - Phone:502-637-6345
Mailing Address - Fax:
Practice Address - Street 1:3906 DUPONT SQ S
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4647
Practice Address - Country:US
Practice Address - Phone:502-893-6654
Practice Address - Fax:502-893-0000
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1880104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0644094Medicare ID - Type Unspecified