Provider Demographics
NPI:1235665548
Name:COOPER-PUCKETT, AMY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:COOPER-PUCKETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-1786
Mailing Address - Country:US
Mailing Address - Phone:859-309-6245
Mailing Address - Fax:
Practice Address - Street 1:137 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-1786
Practice Address - Country:US
Practice Address - Phone:859-309-6245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical