Provider Demographics
NPI:1891740635
Name:DISPONETT, KAREL (PHD)
Entity Type:Individual
Prefix:
First Name:KAREL
Middle Name:
Last Name:DISPONETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6274 OLD BLOOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40008-7602
Mailing Address - Country:US
Mailing Address - Phone:502-490-0198
Mailing Address - Fax:502-348-0121
Practice Address - Street 1:114 N 5TH ST
Practice Address - Street 2:SUITE 11
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1449
Practice Address - Country:US
Practice Address - Phone:502-507-9765
Practice Address - Fax:502-348-0121
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0051101YP2500X
KY2007-67103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK100550Medicare PIN
KY000000506502OtherANTHEM
KY00199016Medicare PIN
KY00201016Medicare PIN
KY00205014Medicare PIN
KY0690960Medicare PIN
KY0762260Medicare PIN
KY0762356Medicare PIN
11574912OtherCAQH
KY30605018Medicaid
KY00206014Medicare PIN
KY00207014Medicare PIN
KY0763556Medicare PIN
KY0974729Medicare PIN