Provider Demographics
NPI:1437250602
Name:LINEBERGER, MABLE ROWE (PHD)
Entity Type:Individual
Prefix:
First Name:MABLE
Middle Name:ROWE
Last Name:LINEBERGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E COLLEGE ST
Mailing Address - Street 2:#1
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-1603
Mailing Address - Country:US
Mailing Address - Phone:502-570-8400
Mailing Address - Fax:502-570-9221
Practice Address - Street 1:101 E COLLEGE ST
Practice Address - Street 2:#1
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-1603
Practice Address - Country:US
Practice Address - Phone:502-570-8400
Practice Address - Fax:502-570-9221
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0822103TA0400X, 103TB0200X, 103TC0700X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYTKY 2054OtherCLEARSPRINGS
KY93015OtherMENTAL HEALTH NETWORK
KYK013663OtherCHAMPUS
KY6102963OtherUNITED BEHAVIORAL HEALTH
KY044704OtherVALUE-OPTIONS
KY000000069184OtherBLUE CROSS BLUE SHIELD
KYC61009OtherCUMBERLAND HEALTHCARE
KYK013663OtherCHAMPUS