Provider Demographics
NPI:1619014842
Name:MAGGARD, SAMUEL ROBISON (MSSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:ROBISON
Last Name:MAGGARD
Suffix:
Gender:M
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 DAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3737
Mailing Address - Country:US
Mailing Address - Phone:502-644-5258
Mailing Address - Fax:
Practice Address - Street 1:3308 DAYTON AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3737
Practice Address - Country:US
Practice Address - Phone:502-644-5258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical