Provider Demographics
NPI:1225084817
Name:PORTER PROCTOR, CATHERINE (LCSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:PORTER PROCTOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 W MUHAMMAD ALI BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1423
Mailing Address - Country:US
Mailing Address - Phone:502-589-8600
Mailing Address - Fax:502-589-8745
Practice Address - Street 1:130 S JOE B HALL AVE
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6009
Practice Address - Country:US
Practice Address - Phone:502-955-6445
Practice Address - Fax:502-955-9605
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000210189OtherANTHEM
KY30605018Medicaid
11490721OtherCAQH
KY341187OtherTRICARE
KY7100288020Medicaid
KY7100288020Medicaid
11490721OtherCAQH
KY0358855Medicare ID - Type UnspecifiedMEDICARE
KY30605018Medicaid
P06617Medicare UPIN
KY0763524Medicare ID - Type UnspecifiedMEDICARE
KY0358755Medicare ID - Type UnspecifiedMEDICARE
KY0358654Medicare ID - Type UnspecifiedMEDICARE
KY0359055Medicare ID - Type UnspecifiedMEDICARE
KY0762227Medicare ID - Type UnspecifiedMEDICARE