Provider Demographics
NPI:1346341864
Name:BOONE, EMILY CLARK (MSW LCSW ACSW BCD)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:CLARK
Last Name:BOONE
Suffix:
Gender:F
Credentials:MSW LCSW ACSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 POPE STREET
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-3119
Mailing Address - Country:US
Mailing Address - Phone:502-585-3430
Mailing Address - Fax:502-585-3443
Practice Address - Street 1:102 POPE STREET
Practice Address - Street 2:SUITE # 1
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-3119
Practice Address - Country:US
Practice Address - Phone:502-585-3430
Practice Address - Fax:502-585-3443
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1081041C0700X
IN34000343A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical