Provider Demographics
NPI:1619900784
Name:HUHN, MARY D (LISW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:D
Last Name:HUHN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 FAIRFIELD AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BELLEVUE
Mailing Address - State:KY
Mailing Address - Zip Code:41073
Mailing Address - Country:US
Mailing Address - Phone:859-261-8483
Mailing Address - Fax:859-261-8483
Practice Address - Street 1:227 FAIRFIELD AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BELLEVUE
Practice Address - State:KY
Practice Address - Zip Code:41073
Practice Address - Country:US
Practice Address - Phone:859-261-8483
Practice Address - Fax:859-261-8483
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI5088104100000X
KY08161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HUSW14261Medicare ID - Type Unspecified