Provider Demographics
NPI:1659515757
Name:CHILD, AMY LAUREN
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LAUREN
Last Name:CHILD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LAUREN
Other - Last Name:BURGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:343 WALLER AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2912
Mailing Address - Country:US
Mailing Address - Phone:859-271-9448
Mailing Address - Fax:859-272-6893
Practice Address - Street 1:343 WALLER AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2912
Practice Address - Country:US
Practice Address - Phone:859-271-9448
Practice Address - Fax:859-272-6893
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker