Provider Demographics
NPI:1710060132
Name:DENNIS, MAREEN C (MS, LPP)
Entity Type:Individual
Prefix:
First Name:MAREEN
Middle Name:C
Last Name:DENNIS
Suffix:
Gender:F
Credentials:MS, LPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 FOUNTAIN CT DEPT OF
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1888
Mailing Address - Country:US
Mailing Address - Phone:859-323-6021
Mailing Address - Fax:859-323-4927
Practice Address - Street 1:245 FOUNTAIN CT DEPT OF
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1888
Practice Address - Country:US
Practice Address - Phone:859-323-6021
Practice Address - Fax:859-323-4927
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY114312103TC0700X, 103TC2200X
KY0347103TC1900X, 103T00000X, 103TP2701X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy