Provider Demographics
NPI:1598747610
Name:LITZENBERGER, KATHLEEN LOUISE (LCSW, ACSW DCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:LITZENBERGER
Suffix:
Gender:F
Credentials:LCSW, ACSW DCSW
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:L
Other - Last Name:LITZENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, DCSW, ACSW
Mailing Address - Street 1:4506 YAGER LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-1723
Mailing Address - Country:US
Mailing Address - Phone:336-686-2157
Mailing Address - Fax:
Practice Address - Street 1:7204 HIGHWAY 329 STE 102
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-8875
Practice Address - Country:US
Practice Address - Phone:336-686-2157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0039031041C0700X
KY2544671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC134NFOtherBLUE CROSS BLUE SHIELD
NC1598747610OtherHUMANA
NC1598747610OtherCHOICE CARE
NC1598747610OtherOPTUM
6329720OtherCIGNA
NC134-NFOtherANTHEM
NC1598747610OtherUBH
NC1598757610OtherCHOICE CARE
331055OtherTRICARE
NC6002261Medicaid
KY7100878370Medicaid