Provider Demographics
NPI:1063818607
Name:NOONAN, MARY LUKE (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LUKE
Last Name:NOONAN
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E. MUHAMMAD ALI BLVD.
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-568-6758
Mailing Address - Fax:
Practice Address - Street 1:700 E MUHAMMAD ALI BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1643
Practice Address - Country:US
Practice Address - Phone:025-686-7585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
COACB.0007826OtherCAC II