Provider Demographics
NPI:1659814721
Name:WORKMAN, BERTHA (PEER SUPPORT SPECIAL)
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:
Last Name:WORKMAN
Suffix:
Gender:F
Credentials:PEER SUPPORT SPECIAL
Other - Prefix:
Other - First Name:BERTHA
Other - Middle Name:
Other - Last Name:WORKMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PEER SUPPORT SPECIAL
Mailing Address - Street 1:331 SOUTH 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066
Mailing Address - Country:US
Mailing Address - Phone:270-251-2943
Mailing Address - Fax:170-251-2943
Practice Address - Street 1:331 SOUTH 7TH STREET
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066
Practice Address - Country:US
Practice Address - Phone:270-251-2943
Practice Address - Fax:170-251-2943
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable