Provider Demographics
NPI:1609839539
Name:ACRA, PAUL DOUGLAS (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DOUGLAS
Last Name:ACRA
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3175 CUSTER DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4023
Mailing Address - Country:US
Mailing Address - Phone:859-273-1288
Mailing Address - Fax:859-273-1278
Practice Address - Street 1:3175 CUSTER DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4023
Practice Address - Country:US
Practice Address - Phone:859-273-1288
Practice Address - Fax:859-273-1278
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14L101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000273363OtherANTHEM BC/BS
KY82000472Medicaid
KYS16406Medicare UPIN
KY0679203Medicare ID - Type Unspecified