Provider Demographics
NPI:1578732533
Name:OLDHAM, VERNON LEE (MSSW)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:LEE
Last Name:OLDHAM
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 CHAMPION CT
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-5379
Mailing Address - Country:US
Mailing Address - Phone:502-319-5588
Mailing Address - Fax:502-352-1082
Practice Address - Street 1:1403 LOUISVILLE RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-3914
Practice Address - Country:US
Practice Address - Phone:502-352-6931
Practice Address - Fax:502-352-1082
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional