Provider Demographics
NPI:1508909102
Name:STANLEY, WILLIAM ROBERT (LCSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROBERT
Last Name:STANLEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 BAXTER AVE
Mailing Address - Street 2:UNIT ONE
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1605
Mailing Address - Country:US
Mailing Address - Phone:502-587-0711
Mailing Address - Fax:502-587-0144
Practice Address - Street 1:1027 BAXTER AVE
Practice Address - Street 2:UNIT ONE
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1605
Practice Address - Country:US
Practice Address - Phone:502-587-0711
Practice Address - Fax:502-587-0144
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCSW0209Medicare ID - Type Unspecified