Provider Demographics
NPI:1073566220
Name:RICKERT, VERNON C JR (LCSW LMFT)
Entity Type:Individual
Prefix:MR
First Name:VERNON
Middle Name:C
Last Name:RICKERT
Suffix:JR
Gender:M
Credentials:LCSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17501 FISHERVILLE WOODS DR
Mailing Address - Street 2:
Mailing Address - City:FISHERVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40023-9781
Mailing Address - Country:US
Mailing Address - Phone:502-267-5418
Mailing Address - Fax:502-618-2609
Practice Address - Street 1:9319 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1737
Practice Address - Country:US
Practice Address - Phone:502-592-8195
Practice Address - Fax:502-618-2609
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02141041C0700X
KY0252106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCSW0302Medicare UPIN