Provider Demographics
NPI:1518126556
Name:SEWELL, ROBERTA HART (MS, CADC)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:HART
Last Name:SEWELL
Suffix:
Gender:F
Credentials:MS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 BARRET AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1667
Mailing Address - Country:US
Mailing Address - Phone:502-451-1221
Mailing Address - Fax:502-451-1334
Practice Address - Street 1:1028 BARRET AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1667
Practice Address - Country:US
Practice Address - Phone:502-451-1221
Practice Address - Fax:502-451-1334
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0173101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)