Provider Demographics
NPI:1174826523
Name:PRYOR, DONNA J (MSSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:J
Last Name:PRYOR
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 1:2520 BARDSTOWN RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2672
Mailing Address - Country:US
Mailing Address - Phone:502-693-5070
Mailing Address - Fax:
Practice Address - Street 1:2520 BARDSTOWN RD
Practice Address - Street 2:SUITE 8
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2672
Practice Address - Country:US
Practice Address - Phone:502-693-5070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40521041C0700X
IN33005888A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100359060Medicaid
KY4052OtherLICENSED CLINICAL SOCIAL WORKER
IN33005888AOtherLICENSED SOCIAL WORKER