Provider Demographics
NPI:1275066136
Name:FIELDS-LEVAN, MARY (LCSW, LISW-S)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:FIELDS-LEVAN
Suffix:
Gender:F
Credentials:LCSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 HOUSTON RD
Mailing Address - Street 2:SUITE 29
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-4873
Mailing Address - Country:US
Mailing Address - Phone:859-746-9272
Mailing Address - Fax:859-746-9322
Practice Address - Street 1:7000 HOUSTON RD
Practice Address - Street 2:SUITE 29
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4873
Practice Address - Country:US
Practice Address - Phone:859-746-9272
Practice Address - Fax:859-746-9322
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.15012501041C0700X
KY2524101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical