Provider Demographics
NPI: | 1437118130 |
---|---|
Name: | HOSEY, MARY RYAN (LCSW) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | MARY |
Middle Name: | RYAN |
Last Name: | HOSEY |
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: | 214 BRECKENRIDGE LN |
Mailing Address - Street 2: | SUITE 114 |
Mailing Address - City: | LOUISVILLE |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40207-3868 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 502-609-0197 |
Mailing Address - Fax: | 502-327-7705 |
Practice Address - Street 1: | 214 BRECKENRIDGE LN |
Practice Address - Street 2: | SUITE 114 |
Practice Address - City: | LOUISVILLE |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40207-3868 |
Practice Address - Country: | US |
Practice Address - Phone: | 502-609-0197 |
Practice Address - Fax: | 502-327-7705 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-03-21 |
Last Update Date: | 2010-10-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KY | 1002 | 1041C0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | CK5471 | Other | RAILROAD MEDICARE |
KY | 800013963 | Other | RAILROAD MEDICARE |
KY | CK5471 | Other | RAILROAD MEDICARE |
KY | 0241322 | Medicare ID - Type Unspecified |