Provider Demographics
NPI:1508316258
Name:HAYES, KIMBERLY (LISW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 E NEW CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-4145
Mailing Address - Country:US
Mailing Address - Phone:859-428-7627
Mailing Address - Fax:859-479-3228
Practice Address - Street 1:8040 HOSBROOK RD STE 102
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2908
Practice Address - Country:US
Practice Address - Phone:859-359-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2541071041C0700X
OHI.22038571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100712910Medicaid