Provider Demographics
NPI:1376951434
Name:LIVERS, VIRGIL WILLIAM MATTHEW
Entity Type:Individual
Prefix:MR
First Name:VIRGIL
Middle Name:WILLIAM MATTHEW
Last Name:LIVERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-1812
Mailing Address - Country:US
Mailing Address - Phone:502-751-6200
Mailing Address - Fax:
Practice Address - Street 1:4216 S 1ST ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-1812
Practice Address - Country:US
Practice Address - Phone:502-751-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker