Provider Demographics
NPI:1053853028
Name:GOOCH, ANIKA (MSSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ANIKA
Middle Name:
Last Name:GOOCH
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 OLD LAFAYETTE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1998
Mailing Address - Country:US
Mailing Address - Phone:859-687-7007
Mailing Address - Fax:859-687-7007
Practice Address - Street 1:118 OLD LAFAYETTE AVE STE 1
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502
Practice Address - Country:US
Practice Address - Phone:859-687-7007
Practice Address - Fax:859-687-7007
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2538631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100579410Medicaid