Provider Demographics
NPI:1659426591
Name:CAUDILL, JOSEPH MEDFORD (LCSW)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MEDFORD
Last Name:CAUDILL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 SAYRE AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2317
Mailing Address - Country:US
Mailing Address - Phone:859-806-0026
Mailing Address - Fax:859-259-1301
Practice Address - Street 1:637 SAYRE AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2317
Practice Address - Country:US
Practice Address - Phone:859-806-0026
Practice Address - Fax:859-259-1301
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical