Provider Demographics
NPI:1760776686
Name:ARIAS, SUSAN NOVELLA (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:NOVELLA
Last Name:ARIAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:NOVELLA
Other - Last Name:LEIRMOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:629 N WILSON RD
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-2131
Mailing Address - Country:US
Mailing Address - Phone:270-319-4911
Mailing Address - Fax:270-319-4912
Practice Address - Street 1:629 N WILSON RD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-2131
Practice Address - Country:US
Practice Address - Phone:270-319-4911
Practice Address - Fax:270-319-4912
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50861041C0700X
KY6019104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100386600Medicaid