Provider Demographics
NPI:1326478850
Name:PAVLOV, RUBEN (LCADC)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:PAVLOV
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1716
Mailing Address - Country:US
Mailing Address - Phone:502-583-3951
Mailing Address - Fax:502-581-9234
Practice Address - Street 1:4400 BRECKENRIDGE LN STE 126
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4082
Practice Address - Country:US
Practice Address - Phone:502-493-7794
Practice Address - Fax:502-493-7795
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYADCLAD00166934101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)