Provider Demographics
NPI:1104204197
Name:GORE, ANTHONY C (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:C
Last Name:GORE
Suffix:
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 1:1700 UPS DR STE 107
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4046
Mailing Address - Country:US
Mailing Address - Phone:502-339-4511
Mailing Address - Fax:502-339-4513
Practice Address - Street 1:1700 UPS DR STE 107
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4046
Practice Address - Country:US
Practice Address - Phone:502-339-4511
Practice Address - Fax:502-339-4513
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical