Provider Demographics
NPI:1902196918
Name:NELSON, RAYNA L (LCSW)
Entity Type:Individual
Prefix:
First Name:RAYNA
Middle Name:L
Last Name:NELSON
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 1:4400 BRECKENRIDGE LN
Mailing Address - Street 2:100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-4135
Mailing Address - Country:US
Mailing Address - Phone:502-777-3516
Mailing Address - Fax:
Practice Address - Street 1:4400 BRECKENRIDGE LN
Practice Address - Street 2:100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4135
Practice Address - Country:US
Practice Address - Phone:502-777-3516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical