Provider Demographics
NPI:1790739787
Name:KERSEY, NORMA (LCSW)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:
Last Name:KERSEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CRANES ROOST CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-3650
Mailing Address - Country:US
Mailing Address - Phone:270-765-2605
Mailing Address - Fax:270-766-1222
Practice Address - Street 1:300 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1492
Practice Address - Country:US
Practice Address - Phone:270-259-4652
Practice Address - Fax:270-259-6655
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000044414OtherANTHEM
KY30605018Medicaid
KY341180OtherTRICARE
11574922OtherCAQH
KY0359035Medicare PIN
KY0358602Medicare PIN
KY341180OtherTRICARE
KY0358733Medicare PIN
KY0359232Medicare PIN
KY0358836Medicare PIN
KY30605018Medicaid
KY0026640Medicare PIN