Provider Demographics
NPI:1942675111
Name:SHIPLEY, SAMANTHA DEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DEAN
Last Name:SHIPLEY
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 1:120 CHRYSALIS CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2604
Mailing Address - Country:US
Mailing Address - Phone:859-243-0972
Mailing Address - Fax:859-254-1418
Practice Address - Street 1:120 CHRYSALIS CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2604
Practice Address - Country:US
Practice Address - Phone:859-243-0972
Practice Address - Fax:859-254-1418
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7363104100000X
KY2528971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker