Provider Demographics
NPI:1093907081
Name:CUMBERLAND VALLEY PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:CUMBERLAND VALLEY PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PRATHIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-864-0510
Mailing Address - Street 1:202 W 7TH ST
Mailing Address - Street 2:SUITE 113
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1763
Mailing Address - Country:US
Mailing Address - Phone:606-864-0510
Mailing Address - Fax:606-864-0512
Practice Address - Street 1:202 W 7TH ST
Practice Address - Street 2:SUITE 113
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1763
Practice Address - Country:US
Practice Address - Phone:606-864-0510
Practice Address - Fax:606-864-0512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY402112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64129547Medicaid
KY000000542702OtherBCBS OF KY
KY64129547Medicaid
00380Medicare PIN