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
StateLicense IDTaxonomies
KY10021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCK5471OtherRAILROAD MEDICARE
KY800013963OtherRAILROAD MEDICARE
KYCK5471OtherRAILROAD MEDICARE
KY0241322Medicare ID - Type Unspecified