Provider Demographics
NPI:1871232942
Name:WHALEN, MARA ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:ELIZABETH
Last Name:WHALEN
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 1:1106 TUNNEL HILL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8026
Mailing Address - Country:US
Mailing Address - Phone:270-765-2335
Mailing Address - Fax:270-765-2557
Practice Address - Street 1:728 FAULKNER AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-1800
Practice Address - Country:US
Practice Address - Phone:859-559-6759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2568331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty