Provider Demographics
NPI:1831475169
Name:GULICK, MARY KINGSBURY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KINGSBURY
Last Name:GULICK
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 1:1000 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-3210
Mailing Address - Country:US
Mailing Address - Phone:502-882-5861
Mailing Address - Fax:
Practice Address - Street 1:1000 S 5TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-3210
Practice Address - Country:US
Practice Address - Phone:502-893-3900
Practice Address - Fax:502-882-9237
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical